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Pressanto C, Scholtz S, Ali N. Obesity and bariatric surgery in adults living with severe mental illness: perceptions and clinical challenges. BJPsych Bull 2022; 47:165-171. [PMID: 35698857 DOI: 10.1192/bjb.2022.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Overweight and obesity are twice as likely to develop in people living with severe mental illness (SMI), compared with those without. Many factors contribute to this, such as reduced physical activity and the use of certain medications that induce weight gain. Obesity contributes to the premature mortality seen in people living with SMI, as it is one of the fundamental risk factors for cardiovascular disease and diabetes. Bariatric surgery is an effective treatment option, although patients living with SMI might face stigma when being considered for surgical intervention. This article proposes a discussion around obesity and bariatric surgery in patients living with SMI. It will also reflect on the challenges faced by healthcare professionals and patients living with SMI and obesity, when considering appropriate treatments for weight loss. The paper utilises a fictional case, informed by contributions from a lived experience author, to explore bariatric surgery in people living with SMI.
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Affiliation(s)
| | - Samantha Scholtz
- St Mary's Hospital, Imperial College Healthcare NHS Trust, UK.,West London NHS Trust, UK
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Kwak YB, Kim JY. [Development and Evaluation of an Integrated Health Management Program for Psychiatric Patients with Metabolic Syndrome]. J Korean Acad Nurs 2022; 52:261-277. [PMID: 35818876 DOI: 10.4040/jkan.21222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/18/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE This study developed an integrated health management program for metabolic syndrome in psychiatric patients and examined its effects on self-efficacy, healthy lifestyle, physiological indicators, knowledge of metabolic syndrome, attitudes toward healthy behavior, and social support. METHODS A non-equivalent control group pretest posttest design was used. The participants were 65 psychiatric patients with metabolic syndrome in psychiatric rehabilitation centers, with 33 in the experimental group and 32 in the control group. The experimental group participants engaged in daily mobile application and walking exercises three times a week for more than 40 minutes over 8 weeks, while those in the control group were provided education booklets. The outcomes were measured using self-report questionnaires, anthropometrics, and blood analyses. Intervention effects were analyzed using the independent t-test, Mann-Whitney U test, ANCOVA, and Ranked ANCOVA. RESULTS The experimental group showed a significant increase in self-efficacy (F = 8.85, p = .004, ηp² = .13) and knowledge of metabolic syndrome (t = 2.60, p = .012, d = 0.60) compared to the control group. Additionally, the experimental group demonstrated a significant decrease in waist circumference (Z = -2.34, p = .009, d = 0.58) and body mass index (Z = -1.91, p = .028, d = 0.47) compared to the control group. CONCLUSION The integrated health management program for psychiatric patients with metabolic syndrome is effective in improving self-efficacy and knowledge of metabolic syndrome and decreasing physiological indicators such as waist circumference and body mass index.
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Affiliation(s)
- Yun Bock Kwak
- College of Nursing, Jeonbuk National University, Jeonju, Korea
| | - Ji Young Kim
- College of Nursing, Jeonbuk National University, Jeonju, Korea.,Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.
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Haddad R, Badke D'Andrea C, Ricchio A, Evanoff B, Morrato EH, Parks J, Newcomer JW, Nicol GE. Using Innovation-Corps (I-Corps™) Methods to Adapt a Mobile Health (mHealth) Obesity Treatment for Community Mental Health Settings. Front Digit Health 2022; 4:835002. [PMID: 35721796 PMCID: PMC9197731 DOI: 10.3389/fdgth.2022.835002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background We employed Innovation Corps (I-Corps™) methods to adaptation of a mobile health (mHealth) short-message-system (SMS) -based interactive obesity treatment approach (iOTA) for adults with severe mentall illness receiving care in community settings. Methods We hypothesized "jobs to be done" in three broad stakeholder groups: "decision makers" (DM = state and community clinic administrators), "clinician consumers" (CC = case managers, peer supports, nurses, prescribers) and "service consumers" (SC = patients, peers and family members). Semistructured interviews (N = 29) were recorded and transcribed ver batim and coded based on pragmatic-variant grounded theory methods. Results Four themes emerged across groups: education, inertia, resources and ownership. Sub-themes in education and ownership differed between DM and CC groups on implementation ownership, intersecting with professional development, suggesting the importance of training and supervision in scalability. Sub-themes in resources and intertia differed between CC and SC groups, suggesting illness severity and access to healthy food as major barriers to engagement, whereas the SC group identified the need for enhanced emotional support, in addition to pragmatic skills like menu planning and cooking, to promote health behavior change. Although SMS was percieved as a viable education and support tool, CC and DM groups had limited familiarity with use in clinical care delivery. Conclusions Based on customer discovery, the characteristics of a minimum viable iOTA for implementation, scalability and sustainability include population- and context-specific adaptations to treatment content, interventionist training and delivery mechanism. Successful implementation of an SMS-based intervention will likely require micro-adaptations to fit specific clinical settings.
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Affiliation(s)
- Rita Haddad
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Carolina Badke D'Andrea
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Amanda Ricchio
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Bradley Evanoff
- Center for Healthy Work, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Elaine H. Morrato
- Parkinson School of Health Sciences and Public Health, Loyola University of Chicago, Chicago, IL, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Joseph Parks
- National Council for Mental Wellbeing, Washington, DC, United States
| | - John W. Newcomer
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Thriving Mind South Florida, Miami, FL, United States
| | - Ginger E. Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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54
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Tuda D, Stefancic A, Hawes M, Wang X, Guo S, Cabassa LJ. Correlates of Attendance in a Peer-Led Healthy Lifestyle Intervention for People with Serious Mental Illness Living in Supportive Housing. Community Ment Health J 2022; 58:761-769. [PMID: 34417635 PMCID: PMC8858335 DOI: 10.1007/s10597-021-00881-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
Healthy lifestyle interventions can improve the physical health of people with serious mental illness (SMI; e.g., schizophrenia). Yet, people with SMI report challenges participating in these interventions, thus limiting their potential benefits. This study examined attendance of participants (N = 155), largely comprised of racial and ethnic minorities, in a peer-led healthy lifestyle intervention living in supportive housing. A logistic regression model was used to identify correlates associated with attendance. Results indicated that females, those with at least a high school education, and a diagnosis of schizophrenia were more likely to attend. In contrast, the odds of attending at least one session were significantly lower for those who reported any drug use and for those who rated their health as good or excellent. Our findings indicate certain subgroups of people with SMI could benefit from tailored motivational strategies and supports to improve their participation in healthy lifestyle interventions. clinicaltrials.gov (NCT02175641).
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Affiliation(s)
- Daniela Tuda
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Mark Hawes
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Xiaoyan Wang
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Shenyang Guo
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
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Rossom RC, Crain AL, O’Connor PJ, Waring SC, Hooker SA, Ohnsorg K, Taran A, Kopski KM, Sperl-Hillen JM. Effect of Clinical Decision Support on Cardiovascular Risk Among Adults With Bipolar Disorder, Schizoaffective Disorder, or Schizophrenia: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220202. [PMID: 35254433 PMCID: PMC8902652 DOI: 10.1001/jamanetworkopen.2022.0202] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Adults with schizophrenia, schizoaffective disorder, or bipolar disorder, collectively termed serious mental illness (SMI), have shortened life spans compared with people without SMI. The leading cause of death is cardiovascular (CV) disease. OBJECTIVE To assess whether a clinical decision support (CDS) system aimed at primary care clinicians improves CV health for adult primary care patients with SMI. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized clinical trial conducted from March 2, 2016, to September 19, 2018, restricted randomization assigned 76 primary care clinics in 3 Midwestern health care systems to receive or not receive a CDS system aimed at improving CV health among patients with SMI. Eligible clinics had at least 20 patients with SMI; clinicians and their adult patients with SMI with at least 1 modifiable CV risk factor not at the goal set by the American College of Cardiology/American Heart Association guidelines were included. Statistical analysis was conducted on an intention-to-treat basis from January 10, 2019, to December 29, 2021. INTERVENTION The CDS system assessed modifiable CV risk factors and provided personalized treatment recommendations to clinicians and patients. MAIN OUTCOMES AND MEASURES Patient-level change in total modifiable CV risk over 12 months, summed from individual modifiable risk factors (smoking, body mass index, low-density lipoprotein cholesterol level, systolic blood pressure, and hemoglobin A1c level). RESULTS A total of 80 clinics were randomized; 4 clinics were excluded for having fewer than 20 eligible patients, leaving 42 intervention clinics and 34 control clinics. A total of 8937 patients with SMI (4922 women [55.1%]; mean [SD] age, 48.4 [13.5] years) were enrolled. There was a 4% lower rate of increase in total modifiable CV risk among intervention patients relative to control patients (relative rate ratio [RR], 0.96; 95% CI, 0.94-0.98). The intervention favored patients who were 18 to 29 years of age (RR, 0.89; 95% CI, 0.81-0.98) or 50 to 59 years of age (RR, 0.93; 95% CI, 0.90-0.96), Black (RR, 0.93; 95% CI, 0.88-0.98), or White (RR, 0.96; 95% CI, 0.94-0.98). Men (RR, 0.96; 95% CI, 0.94-0.99) and women (RR, 0.95; 95% CI, 0.92-0.97), as well as patients with any SMI subtype (bipolar disorder: RR, 0.96; 95% CI, 0.94-0.99; schizoaffective disorder: RR, 0.94; 95% CI, 0.90-0.98; schizophrenia: RR, 0.92; 95% CI, 0.85-0.99) also benefited from the intervention. Despite treatment effects favoring the intervention, there were no significant differences in individual modifiable risk factors. CONCLUSIONS AND RELEVANCE This CDS intervention resulted in a rate of change in total modifiable CV risk that was 4% lower among intervention patients compared with control patients. Results were driven by the cumulative effects of incremental and mostly nonsignificant changes in individual modifiable risk factors. These findings emphasize the value of using CDS to prompt early primary care intervention for adults with SMI. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02451670.
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Affiliation(s)
- Rebecca C. Rossom
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - A. Lauren Crain
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | | | - Stephen C. Waring
- Essentia Health and Essentia Institute of Rural Health, Duluth, Minnesota
| | | | - Kris Ohnsorg
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - Allise Taran
- Essentia Health and Essentia Institute of Rural Health, Duluth, Minnesota
| | - Kristen M. Kopski
- Park Nicollet Health Services, Minneapolis, Minnesota
- Now with Medica Health Plan, Minnetonka, Minnesota
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Browne J, Harvey PD, Buchanan RW, Kelly DL, Strauss GP, Gold JM, Holden JL, Granholm E. A Longitudinal Examination of Real-World Sedentary Behavior in Adults with Schizophrenia-Spectrum Disorders in a Clinical Trial of Combined Oxytocin and Cognitive Behavioral Social Skills Training. Behav Sci (Basel) 2022; 12:bs12030060. [PMID: 35323379 PMCID: PMC8945120 DOI: 10.3390/bs12030060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 12/11/2022] Open
Abstract
Sedentary behavior contributes to a shortened life expectancy in individuals with schizophrenia-spectrum disorders (SSDs), highlighting the need for effective interventions to improve health. This study examined whether reduced ecological momentary assessment (EMA) measures of sedentary activities were observed in individuals with SSDs who participated in a 24-week randomized trial of cognitive behavioral social skills training (CBSST) and either intranasal oxytocin or placebo (NCT01752712). Participants (n = 57) were prompted with EMA surveys seven times per day for seven days during the baseline, 12-week, and 24-week timepoints to sample sedentary behavior ratings, positive and negative affect, interpersonal interactions, and interpersonal interaction appraisals. Results revealed that sedentary behavior and social interactions did not significantly change over the 24-week clinical trial; however, positive and negative affect and defeatist interaction appraisals improved with treatment, and oxytocin produced modest additional improvements in these EMA outcomes. Greater momentary positive affect was significantly associated with greater activity and greater frequency of interactions. Overall, CBSST was effective at improving functioning, momentary affect, and defeatist interaction appraisals, although it did not reduce sedentary behavior; therefore, targeting these factors is not sufficient to reduce sedentary behavior, and adjunct interventions are needed.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC 27705, USA
- Correspondence:
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL 33125, USA
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; (R.W.B.); (D.L.K.); (J.M.G.)
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; (R.W.B.); (D.L.K.); (J.M.G.)
| | | | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; (R.W.B.); (D.L.K.); (J.M.G.)
| | - Jason L. Holden
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (J.L.H.); (E.G.)
| | - Eric Granholm
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (J.L.H.); (E.G.)
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA 92093, USA
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Yuan CT, McGinty EE, Dalcin A, Goldsholl S, Dickerson F, Gudzune KA, Jerome GJ, Thompson DA, Murphy KA, Minahan E, Daumit GL. Scaling Evidence-Based Interventions to Improve the Cardiovascular Health of People With Serious Mental Illness. Front Psychiatry 2022; 13:793146. [PMID: 35185650 PMCID: PMC8855048 DOI: 10.3389/fpsyt.2022.793146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
People with serious mental illnesses (SMIs) experience excess mortality, driven in large part by high rates of cardiovascular disease (CVD), with all cardiovascular disease risk factors elevated. Interventions designed to improve the cardiovascular health of people with SMI have been shown to lead to clinically significant improvements in clinical trials; however, the uptake of these interventions into real-life clinical settings remains limited. Implementation strategies, which constitute the "how to" component of changing healthcare practice, are critical to supporting the scale-up of evidence-based interventions that can improve the cardiovascular health of people with SMI. And yet, implementation strategies are often poorly described and rarely justified theoretically in the literature, limiting the ability of researchers and practitioners to tease apart why, what, how, and when implementation strategies lead to improvement. In this Perspective, we describe the implementation strategies that the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness is using to scale-up three evidenced-based interventions related to: (1) weight loss; (2) tobacco smoking cessation treatment; and (3) hypertension, dyslipidemia, and diabetes care for people with SMI. Building on concepts from the literature on complex health interventions, we focus on considerations related to the core function of an intervention (i.e., or basic purposes of the change process that the health intervention seeks to facilitate) vs. the form (i.e., implementation strategies or specific activities taken to carry out core functions that are customized to local contexts). By clearly delineating how implementation strategies are operationalized to support the interventions' core functions across these three studies, we aim to build and improve the future evidence base of how to adapt, implement, and evaluate interventions to improve the cardiovascular health of people with SMI.
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Affiliation(s)
- Christina T. Yuan
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Kimberly A. Gudzune
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gerald J. Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States
| | - David A. Thompson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Karly A. Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Eva Minahan
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gail L. Daumit
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Aschbrenner KA, Naslund JA, Gorin AA, Mueser KT, Browne J, Wolfe RS, Xie H, Bartels SJ. Group Lifestyle Intervention With Mobile Health for Young Adults With Serious Mental Illness: A Randomized Controlled Trial. Psychiatr Serv 2022; 73:141-148. [PMID: 34189933 DOI: 10.1176/appi.ps.202100047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evidence-based lifestyle interventions tailored to young adults with serious mental illness are needed to reduce their cardiometabolic risk. This study evaluated the effectiveness of a group lifestyle intervention ("PeerFIT") enhanced with mobile health (mHealth) compared with one-on-one mHealth coaching (basic education supported by activity tracking [BEAT]) for young adults with serious mental illness who were overweight or obese. METHODS Participants were young adults ages 18-35 years with serious mental illness and a body mass index ≥25 kg/m2, who were randomly assigned to PeerFIT or BEAT. Research staff collected data at baseline and at 6 and 12 months. Main outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of >50 m on the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS Participants were 150 young adults with a mean ± SD body mass index of 37.1±7.4. Intent-to-treat analyses revealed no significant between-group difference for weight-loss, CRF, or CVD outcomes at 6 and 12 months. Participants in both conditions achieved clinically significant CVD risk reduction, weight loss, and CRF from baseline to 6 and 12 months, and all these improvements were statistically significant (p<0.01). CONCLUSION The PeerFIT group lifestyle intervention was not superior to one-on-one mHealth coaching in achieving clinically significant changes in weight, CRF, and CVD risk reduction. Although both interventions improved outcomes, low-intensity mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - John A Naslund
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Amy A Gorin
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Kim T Mueser
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Julia Browne
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Rosemarie S Wolfe
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Haiyi Xie
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Stephen J Bartels
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
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Mosolov SN, Fedorova EY. The risk of developing cardiovascular disease in bipolar disorder. Clinical and social factors. TERAPEVT ARKH 2022; 93:1556-1561. [DOI: 10.26442/00403660.2021.12.201175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 11/22/2022]
Abstract
Bipolar disorder (BD) is one of the most common mental disorders in the world with high mortality and a hard economic burden. Although suicide is the leading cause of death in BD, cardiovascular disease (CVD) also contributes significantly to this rate, the risk of which is seriously underestimated in BD. A sample assessment was made of current studies focusing on the link between BD and CVD. The search was carried out in the PubMed and eLIBRARY databases for the following keywords: bipolar disorder, psychopharmacology, cardiovascular disease, metabolic syndrome. The association between ВD and vascular disease is large. The analysis of adjusted mortality estimates in patients with bipolar disorder showed a significant contribution of CVD. A detailed study of the mutual influence of bipolar disorder BD and CVD is difficult due to the earlier manifestation of BD in comparison with CVD. Most of the studies have focused on cardiovascular risk factors (CVRFs), which are more common in BD than in the general population. Metabolic syndrome (MS) plays a significant role among CVRFs. The reasons for the development of MS in patients with BD are currently not known for sure, however, the instigated factors are certainly a disturbance of the diet, decreased physical activity, pharmacological therapy, and the lack of early preventive and medical care. Patients with hyperuricemia had a higher risk of developing MS. Lifestyle correction and a reduction of CVFRs, as well as the rational use of certain cardiac drugs can improve the better prognosis of the disease and reduce mortality in patients with BD. The predisposition of patients with BD to CVD is undeniable. It is necessary to consider the high frequency of CVRFs in people with BD, and promptly recommend appropriate treatment and special rehabilitation programs for the prevention of CVD complications, considering the change in affective phases and the applied mood-stabilizing drugs.
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The effect of lifestyle intervention on cardiometabolic risk factors in mental health rehabilitation hostel residents at-risk: a cluster-randomized controlled 15-month trial. Int J Obes (Lond) 2022; 46:926-934. [PMID: 35022545 DOI: 10.1038/s41366-022-01063-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/12/2021] [Accepted: 01/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cardiometabolic disorders contribute to morbidity and mortality in people with severe mental illnesses (SMI), yet lifestyle-intervention efficacy in patients with SMI is unclear. Israel's unique mental-health rehabilitation hostels (MHRHs) provide housing to subjects with SMI. We tested how multi-component lifestyle intervention affects cardiometabolic risk-factors in at-risk SMI populations residing in MHRHs. METHODS In a prospective, cluster-randomized, controlled study, six MHRHs, paired by residents' functioning level, were randomized to lifestyle intervention (nutrition education, physical education), or usual care. Subjects recruited included those with ≥1 of: BMI > 25 kg/m2; plasma triglycerides ≥150 mg/dL; HbA1c ≥ 5.7%; fasting plasma glucose ≥ 100 mg/dL and plasma HDL < 40(men)/ 50(women) mg/dL. Primary outcome was BMI change after 15 months; other outcomes were plasma lipids levels and glycemic control. Low cooperation in one MHRH pair led to their exclusion, the others were assigned to intervention or control. RESULTS Eighty residents were enrolled to intervention groups and 74 to control. Compared to baseline, intervention-arm participants experienced improvements in BMI (-0.83 kg/m2 [-1.36, -0.29] 95%CI), triglycerides (-30.60 mg/dL [-49.39, -11.82]95%CI) and LDL (-15.51 mg/dL [-24.53, -6.50]95%CI) (all P ≤ 0.003). BMI improvement correlated with number of dietitian consultations (r = -0.30; P = 0.001). No significant differences were found between treatment arms in BMI (-0.46 kg/m2 [-1.11, 0.18]95%CI;P = 0.189), triglycerides (-24.70 mg/dL [-57.66, 8.25]95%CI), LDL (-9.24 mg/dL [-20.50, 2.03]95%CI), HDL and glycemic control. CONCLUSIONS Lifestyle intervention significantly improved BMI, LDL and triglycerides compared to baseline in at-risk MHRHs residents with SMI, yet compared to usual care the differences did not reach statistical significance. The association between the number of dietitian's consultations and BMI improvement suggests that programs should highlight participants' adherence.
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Giusti L, Bianchini V, Aggio A, Mammarella S, Salza A, Necozione S, Alunno A, Ferri C, Casacchia M, Roncone R. Twelve-month outcomes in overweight/obese users with mental disorders following a multi-element treatment including diet, physical activity, and positive thinking: The real-world "An Apple a Day" controlled trial. Front Psychiatry 2022; 13:903759. [PMID: 36081460 PMCID: PMC9445251 DOI: 10.3389/fpsyt.2022.903759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
The present study aimed to evaluate the 12-month effectiveness of a real-world weight loss transdiagnostic intervention in overweight/obese participants affected by mental disorders under psychopharmacological treatment. We conducted a real-world, controlled, pragmatic outpatient trial. We allocated 58 overweight/obese adults under psychopharmacological treatment from a mental health outpatient unit and 48 overweight/obese adults from a cardiovascular prevention outpatient unit, and assigned them to an intervention or treatment usual as condition (TAU) enriched by life-style advice. Participants in both intervention groups took part in a diet programme (the modified OMNIHeart dietary protocol) and monitoring of regular aerobic activity. A brief group programme ("An Apple a Day" Metacognitive Training, Apple-MCT) was added in the intervention group of participants affected by mental disorders. The primary outcome was weight loss. Secondary outcomes included anthropometric, clinical, and metabolic variables. Psychopathology and health-related quality of life were also evaluated in the psychiatric sample. At 12 months, both intervention groups showed a more marked mean decrease in weight (6.7 kg, SD: 3.57) than the TAU group (0.32 kg, SD: 1.96), and a statistically significant improvement in metabolic variables compared with the control groups. Furthermore, the participants affected by mental disorders included in the intervention group reported improved health-related quality of life. Our findings suggest the need to implement integrated interventions based on a dietary protocol, physical activity, and modification of cognitive style in overweight/obese users with mental disorders.
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Affiliation(s)
- Laura Giusti
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valeria Bianchini
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Annalisa Aggio
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Silvia Mammarella
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna Salza
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Necozione
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessia Alunno
- Division of Internal Medicine and Nephrology, School of Internal Medicine-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudio Ferri
- Division of Internal Medicine and Nephrology, School of Internal Medicine-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo Casacchia
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rita Roncone
- University Unit Rehabilitation Treatment, Early Interventions in Mental Health-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Aschbrenner KA, Naslund JA, Salwen-Deremer JK, Browne J, Bartels SJ, Wolfe RS, Xie H, Mueser KT. Sleep quality and its relationship to mental health, physical health and health behaviours among young adults with serious mental illness enrolled in a lifestyle intervention trial. Early Interv Psychiatry 2022; 16:106-110. [PMID: 33594828 PMCID: PMC10047807 DOI: 10.1111/eip.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 01/28/2023]
Abstract
AIM To characterize subjective sleep quality and examine its associations with mental health, physical health and health behaviours in a transdiagnostic sample of young adults with serious mental illness (SMI) enrolled in a lifestyle intervention trial. METHODS Baseline data from a lifestyle intervention trial with young adults (ages 18-35 years) with SMI included the Pittsburgh Sleep Quality Index (PSQI), mental health, physical health and health behaviour outcomes. Descriptive statistics and multiple linear regression were used in analyses. RESULTS Of 150 participants, 76% were categorized with poor sleep quality. Depressive symptoms were significantly associated with sleep quality (β = .438, p < .001); however, no association was found with physical health and health behaviours. CONCLUSIONS Young adults with SMI enrolled in lifestyle interventions may benefit from treatment that addresses sleep as part of a comprehensive approach to health promotion with attention to the role of depressive symptoms in sleep quality.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jessica K Salwen-Deremer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Julia Browne
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, North Carolina
| | - Stephen J Bartels
- Department of Medicine, Massachusetts General Hospital, Mongan Institute, Boston, Massachusetts
| | - Rosemarie S Wolfe
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Haiyi Xie
- Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Kim T Mueser
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts.,Department of Psychological & Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts
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Lee C, Piernas C, Stewart C, Michalopoulou M, Hajzadeh A, Edwards R, Aveyard P, Waite F. Identifying effective characteristics of behavioral weight management interventions for people with serious mental illness: A systematic review with a qualitative comparative analysis. Obes Rev 2022; 23:e13355. [PMID: 34672069 PMCID: PMC8952200 DOI: 10.1111/obr.13355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
Abstract
People with serious mental illness (SMI) have identified barriers to engaging in behavioral weight management interventions (BWMIs). We assessed whether BWMIs that addressed these barriers were more effective. First, we systematically reviewed qualitative literature and used a thematic analysis to identify the characteristics of BWMIs that promote engagement for adults with SMI. Second, we systematically reviewed randomized controlled trials (RCTs) of BWMIs in adults with SMI. Data on the characteristics that promoted engagement and weight outcomes were extracted. We then used a crisp-set qualitative comparative analysis (CsQCA) to identify which characteristics were associated with weight loss. For the qualitative review, 20 studies in 515 people with SMI were analyzed and nine characteristics were reported to promote engagement in BWMIs. For the systematic review, 34 RCTs testing 36 interventions in 4305 participants were included. The active interventions resulted in more weight loss (mean = -4.37 to +1 kg at 6 weeks to 18 months follow-up) compared with controls (-1.64 to +3.08 kg). The CsQCA showed BWMIs that offered regular contact, tools to support enactment, and tailored materials were associated with effectiveness. As these are all supplementary strategies, it may be possible to augment BWMIs available for the general population to engage people with SMI.
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Affiliation(s)
- Charlotte Lee
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Carmen Piernas
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Cristina Stewart
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Moscho Michalopoulou
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Anisa Hajzadeh
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Rhiannon Edwards
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
- Bassetlaw HospitalDoncaster and Bassetlaw Teaching Hospitals NHS Foundation TrustWorksopNottinghamshireUK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Felicity Waite
- Department of PsychiatryUniversity of Oxford, Warneford HospitalOxfordOxfordshireUK
- Oxford Health NHS Foundation TrustOxfordOxfordshireUK
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Hui TT, Garvey L, Olasoji M. Improving the physical health of young people with early psychosis with lifestyle interventions: Scoping review. Int J Ment Health Nurs 2021; 30:1498-1524. [PMID: 34390119 DOI: 10.1111/inm.12922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
People with mental illness experience a shorter life expectancy compared to the general population. Poor physical health trajectory emerges following the onset of psychosis and is further compounded by the initiation of antipsychotic treatment. Young people are particularly at risk as the onset of mental illness mostly occurs between the age of 12 and 25 years. This represents a crucial period for early intervention to prevent a physical ill health trajectory. Furthermore, those who are at ultra-high risk for psychosis should also be targeted for early intervention. Lifestyle interventions have been identified as the first-line physical health promotion practice for improving the physical health of people with severe mental illness. The aim of this study was to conduct a scoping review following the JBI methodological guidance on scoping reviews to explore the current literature on lifestyle intervention trialled for early psychosis, including first-episode psychosis and those who are at ultra-high risk for psychosis. This review also explores the extent of literature examining physical health literacy in this specific population. The literature search was conducted on Medline, Embase, PsycINFO and Scopus. Twenty-two studies were included for the purpose of this scoping review, 21 of which examined the effects of lifestyle interventions and one of which reported on physical health literacy. This scoping review indicates the need for co-designed lifestyle interventions with the involvement of service users, families and carers and a focus on promoting physical health literacy, social support, and an incorporation of a health behaviour change model focus on promoting autonomous motivation. The findings of this study can inform future development of a novel co-designed lifestyle intervention for the targeted population.
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Affiliation(s)
- Ting Ting Hui
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology Australia, Hawthorn, Victoria, Australia
| | - Loretta Garvey
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology Australia, Hawthorn, Victoria, Australia
| | - Michael Olasoji
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology Australia, Hawthorn, Victoria, Australia.,School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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Fibbins H, Edwards L, Morell R, Lederman O, Ward P, Curtis J. Implementing an Exercise Physiology Clinic for Consumers Within a Community Mental Health Service: A Real-World Evaluation. Front Psychiatry 2021; 12:791125. [PMID: 34899443 PMCID: PMC8651871 DOI: 10.3389/fpsyt.2021.791125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Physical activity significantly improves mental illness symptoms and physical health for people living with mental illness. Mental health services do not routinely provide their consumers with access to exercise professionals for physical activity engagement. Barriers exist to integrating physical activity as part of standard care including staff culture, finance, and resources. This study examines the feasibility of newly established exercise physiology clinic within a mental health service in Sydney, Australia. Methods: A single site, open trial was conducted in a community centre within a large mental health district. A meeting room was converted into a part-time exercise physiology clinic where individualised physical activity interventions were delivered by an accredited exercise physiologist. Outcome measures including BMI, cardiovascular fitness, and self-reported physical activity were collected. Results: A total of 84 mental health consumers (17% of eligible consumers within the mental health service) participated in the clinic on average for one exercise session weekly. Moderate-to-vigorous physical activity significantly increased and sedentary time significantly decreased (p < 0.001). Conclusions: Exercise physiology clinics are feasible within mental health services and should be incorporated as part of standard care.
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Affiliation(s)
- Hamish Fibbins
- Keeping the Body in Mind, Sydney, NSW, Australia
- School of Psychiatry, UNSW Sydney, Randwick, NSW, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Law Edwards
- Keeping the Body in Mind, Sydney, NSW, Australia
| | - Rachel Morell
- Keeping the Body in Mind, Sydney, NSW, Australia
- School of Psychiatry, UNSW Sydney, Randwick, NSW, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | | | - Philip Ward
- School of Psychiatry, UNSW Sydney, Randwick, NSW, Australia
- Schizophrenia Research Unit, Liverpool Hospital, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Jackie Curtis
- Keeping the Body in Mind, Sydney, NSW, Australia
- School of Psychiatry, UNSW Sydney, Randwick, NSW, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
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McGinty EE, Presskreischer R, Breslau J, Brown JD, Domino ME, Druss BG, Horvitz-Lennon M, Murphy KA, Pincus HA, Daumit GL. Improving Physical Health Among People With Serious Mental Illness: The Role of the Specialty Mental Health Sector. Psychiatr Serv 2021; 72:1301-1310. [PMID: 34074150 PMCID: PMC8570967 DOI: 10.1176/appi.ps.202000768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
People with serious mental illness die 10-20 years earlier, compared with the overall population, and the excess mortality is driven by undertreated physical health conditions. In the United States, there is growing interest in models integrating physical health care delivery, management, or coordination into specialty mental health programs, sometimes called "reverse integration." In November 2019, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness convened a forum of 25 experts to discuss the current state of the evidence on integrated care models based in the specialty mental health system and to identify priorities for future research, policy, and practice. This article summarizes the group's conclusions. Key research priorities include identifying the active ingredients in multicomponent integrated care models and developing and validating integration performance metrics. Key policy and practice recommendations include developing new financing mechanisms and implementing strategies to build workforce and data capacity. Forum participants also highlighted an overarching need to address socioeconomic risks contributing to excess mortality among adults with serious mental illness.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Rachel Presskreischer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Joshua Breslau
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Jonathan D Brown
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marisa Elena Domino
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Benjamin G Druss
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marcela Horvitz-Lennon
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Karly A Murphy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Harold Alan Pincus
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Gail L Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
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Affective disorders, weight change, and patient engagement in a rural behavioral weight loss trial. Prev Med 2021; 152:106698. [PMID: 34175347 DOI: 10.1016/j.ypmed.2021.106698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adults in rural areas have a higher prevalence of obesity and some mental health conditions. The degree to which mental health influences weight loss among rural residents remains unclear. This study evaluated changes in body weight, physical activity, diet, and program engagement outcomes in a cohort of participants with vs. without an affective disorder in a behavioral weight loss trial. METHODS A sample of 1407 adults with obesity were recruited from rural U.S. primary care practices to participate in a weight loss trial. In this secondary analysis, participants were stratified by those with vs. without an affective disorder at baseline. Mixed models were used to estimate changes in outcomes over 24 months. RESULTS One-third of participants (n = 468) had an affective disorder. After covariate adjustment, both groups experienced significant weight loss over 24 months, but weight loss was significantly less among those with an affective disorder at all follow-up times (all p's < 0.001; 24-month weight loss -2.7 ± 0.4 vs. -4.8 ± 0.3 kg). Compared to those without an affective disorder, participants with an affective disorder also had significantly less improvement in physical activity and fruit/vegetable consumption, lower attendance at weight loss sessions, and less engagement in setting weight loss goals and strategies. CONCLUSION Participants with an affective disorder lost less body weight and less improvement in lifestyle measures over 24 months. These trends paralleled reduced engagement in critical intervention activities such as weight loss session attendance. Future interventions should consider additional methods to minimize disengagement in adults with underlying affective disorders.
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Vrany EA, Jennings A, Hossain MB, Hill-Briggs F. Mental Health History and DECIDE (Decision-Making Education for Choices in Diabetes Everyday) Diabetes Support Program Outcomes Among African Americans With Type 2 Diabetes. Sci Diabetes Self Manag Care 2021; 47:425-435. [PMID: 34617828 DOI: 10.1177/26350106211048782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to determine behavioral and clinical outcomes of the DECIDE (Decision-Making Education for Choices in Diabetes Everyday) diabetes support program trial participants with and without a mental health (MH) history by treatment arm. METHODS A secondary analysis was conducted of data from the DECIDE trial sample of urban African American adults with type 2 diabetes (T2DM; N = 137) who received the DECIDE diabetes support program in 1 of 3 delivery formats: self-study (n = 46), individual (n = 45), and group (n = 46). Positive screen on the Patient Health Questionnaire-2 and/or reported MH diagnosis were coded as MH history. Self-management, knowledge, problem-solving, and A1C data at baseline and 1 week and 6 months postintervention were analyzed for participants with and without MH history. RESULTS Prevalence of MH history was 37% in the sample. Among those with no MH history, knowledge and problem-solving improved at 6 months postintervention in all intervention arms. For those with MH history, knowledge and problem-solving improved in the self-study and individual arms but not in the group arm. Clinically but not statistically significant changes in A1C were observed at 6 months. CONCLUSIONS In an urban minority T2DM sample, those with an MH history benefited from the intervention, but delivery format mattered, with robust improvements when participants with an MH history received self-directed or one-on-one formats rather than group.
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Affiliation(s)
- Elizabeth A Vrany
- From Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arianne Jennings
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland
| | - Mian B Hossain
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland
| | - Felicia Hill-Briggs
- From Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Onyeaka H, Firth J, Kessler RC, Lovell K, Torous J. Use of smartphones, mobile apps and wearables for health promotion by people with anxiety or depression: An analysis of a nationally representative survey data. Psychiatry Res 2021; 304:114120. [PMID: 34303946 DOI: 10.1016/j.psychres.2021.114120] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022]
Abstract
People with mental illness have increased cardiovascular risk factors, which contributes significantly to mortality in this population. Digital interventions have emerged as promising models to promote physical health, although their potential for use in mental health populations is relatively unexplored. We examined the potential for using digital tools for health promotion by people with common mental disorders like anxiety or depression. Using data from the 2019 edition of the Health Information National Trends Survey (HINTS 5), we evaluated differences between individuals with self-reported history of diagnosed depression/anxiety and the general population with respect to ownership, usage, and perceived usefulness of digital tools for managing their health. Overall, individuals with anxiety or depression were as likely as the general population to use digital devices for their care. Those with anxiety or depression who had health apps were more likely to report intentions to lose weight than those without health apps. Significant sociodemographic predictors of digital tools usage included gender, age, income, and education level. People with anxiety or depression own and use digital health tools at similarly high rates to the general population, suggesting that these tools present a novel opportunity for health promotion among people with these disorders.
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Affiliation(s)
- Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital/McLean Hospital, Harvard Medical School, Boston, MA, United States
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NICM Health Research Institute, Western Sydney University, Westmead, Australia; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Ronald C Kessler
- Department of HealthCare Policy, Harvard Medical School, Boston, United States
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - John Torous
- Department of Psychiatry, Beth Israeli Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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70
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Aschbrenner KA, Naslund JA, Reed JD, Fetter JC. Renewed call for lifestyle interventions to address obesity among individuals with serious mental illness in the COVID-19 era and beyond. Transl Behav Med 2021; 11:1359-1364. [PMID: 34160055 DOI: 10.1093/tbm/ibab076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Behavioral health has the opportunity to lead the way in using lifestyle interventions to address obesity and health disparities in people with serious mental illness (SMI) in the COVID-19 era. Evidence-based interventions for weight loss in individuals with SMI exist, and the field has developed strategies for implementing these interventions in real-world mental health care settings. In addition to promoting weight loss, lifestyle interventions have the potential to address social isolation and loneliness and other patient-centered outcomes among individuals with SMI, which will be especially valuable for mitigating the growing concerns about loneliness attributed to the COVID-19 pandemic restrictions on in-person encounters. In this commentary, we discuss practice, policy, and research implications related to using evidence-based lifestyle interventions for individuals with SMI during the COVID-19 pandemic and sustaining these programs in the long-term.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jeffrey D Reed
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Jeffrey C Fetter
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
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71
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Cabassa LJ, Stefancic A, Bochicchio L, Tuda D, Weatherly C, Lengnick-Hall R. Organization leaders' decisions to sustain a peer-led healthy lifestyle intervention for people with serious mental illness in supportive housing. Transl Behav Med 2021; 11:1151-1159. [PMID: 32949137 DOI: 10.1093/tbm/ibaa089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Healthy lifestyle interventions that increase physical activity and healthy dietary habits can help improve the physical health of people with serious mental illness (SMI). Yet, these interventions are not implemented in routine practice settings. This mixed methods study examined the decisions that leaders from three supportive housing agencies made as they planned to sustain a peer-led healthy lifestyle intervention for people with SMI at the end of a clinical trial. A combination of implementation strategies that addressed cost concerns, generated local evidence of the intervention's benefits, and provided ongoing training was identified as important for sustainability. A sustainability model illustrating implementation strategies and mechanisms for supporting three sustainability domains (funding, organizational capacity, and adaptation) was prioritized by participants. Study findings can inform future studies testing strategies and mechanisms to support the sustainability of interventions in routine practice settings to improve the physical health of people with SMI.
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Affiliation(s)
- Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis Campus Box 1196, St. Louis, MO, USA
| | - Ana Stefancic
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Daniela Tuda
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Christopher Weatherly
- Brown School of Social Work, Washington University in St. Louis Campus Box 1196, St. Louis, MO, USA
| | - Rebecca Lengnick-Hall
- Brown School of Social Work, Washington University in St. Louis Campus Box 1196, St. Louis, MO, USA
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72
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Adams SC, McMillan J, Salline K, Lavery J, Moskowitz CS, Matsoukas K, Chen MMZ, Santa Mina D, Scott JM, Jones LW. Comparing the reporting and conduct quality of exercise and pharmacological randomised controlled trials: a systematic review. BMJ Open 2021; 11:e048218. [PMID: 34380726 PMCID: PMC8359527 DOI: 10.1136/bmjopen-2020-048218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/15/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Evaluate the quality of exercise randomised controlled trial (RCT) reporting and conduct in clinical populations (ie, adults with or at risk of chronic conditions) and compare with matched pharmacological RCTs. DESIGN Systematic review. DATA SOURCES Embase (Elsevier), PubMed (NLM) and CINAHL (EBSCO). STUDY SELECTION RCTs of exercise in clinical populations with matching pharmacological RCTs published in leading clinical, medical and specialist journals with impact factors ≥15. REVIEW METHODS Overall RCT quality was evaluated by two independent reviewers using three research reporting guidelines (ie, Consolidated Standards of Reporting Trials (CONSORT; pharmacological RCTs)/CONSORT for non-pharmacological treatments; exercise RCTs), CONSORT-Harms, Template for Intervention Description and Replication) and two risk of bias assessment (research conduct) tools (ie, Cochrane Risk of Bias, Jadad Scale). We compared research reporting and conduct quality within exercise RCTs with matched pharmacological RCTs, and examined factors associated with quality in exercise and pharmacological RCTs, separately. FINDINGS Forty-eight exercise RCTs (11 658 patients; median sample n=138) and 48 matched pharmacological RCTs were evaluated (18 501 patients; median sample n=160). RCTs were conducted primarily in cardiovascular medicine (43%) or oncology (31%). Overall quality score (composite of all research reporting and conduct quality scores; primary endpoint) for exercise RCTs was 58% (median score 46 of 80; IQR: 39-51) compared with 77% (53 of 68; IQR: 47-58) in the matched pharmacological RCTs (p≤0.001). Individual quality scores for trial reporting and conduct were lower in exercise RCTs compared with matched pharmacological RCTs (p≤0.03). Factors associated with higher overall quality scores for exercise RCTs were journal impact factor (≥25), sample size (≥152) and publication year (≥2013). CONCLUSIONS AND RELEVANCE Research reporting and conduct quality within exercise RCTs is inferior to matched pharmacological RCTs. Suboptimal RCT reporting and conduct impact the fidelity, interpretation, and reproducibility of exercise trials and, ultimately, implementation of exercise in clinical populations. PROSPERO REGISTRATION NUMBER CRD42018095033.
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Affiliation(s)
- Scott C Adams
- Department of Cardiology, Toronto General Research Institute, Toronto, Ontario, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Julia McMillan
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kirsten Salline
- Internal Medicine, NYU Langone Health, New York, New York, USA
| | - Jessica Lavery
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chaya S Moskowitz
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Maggie M Z Chen
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jessica M Scott
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Lee W Jones
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Medicine, Weill Cornell Medical College, New York, New York, USA
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73
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Cook JA, Jonikas JA, Steigman P, Glover CM, Burke-Miller JK, Weidenaar J, O’Neill S, Pavick D, Jami A, Santos CJ. Registry-Managed Care Coordination and Education for Patients With Co-occurring Diabetes and Serious Mental Illness. Psychiatr Serv 2021; 72:912-919. [PMID: 33887953 PMCID: PMC10443902 DOI: 10.1176/appi.ps.202000096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Longitudinal changes in health outcomes of patients with serious mental illness and co-occurring diabetes were examined after introduction of an intervention involving electronic disease management, care coordination, and personalized patient education. METHODS This observational cohort study included 179 patients with serious mental illness and diabetes mellitus type 2 at a behavioral health home in Chicago. The intervention employed a care coordinator who used a diabetes registry to integrate services; patients also received personalized diabetes self-management education. Outcomes included glucose, lipid, and blood pressure levels as assessed by glycosylated hemoglobin, low-density lipoprotein, triglycerides, and systolic/diastolic values from electronic medical records and completion of specialty visits confirmed with optometrists and podiatrists. Interrupted time-series segmented random-effects regression models tested for level changes in the eight study quarters following intervention implementation compared with eight preimplementation study quarters, controlling for clinic site and preimplementation secular trends. RESULTS Significant declines were found in levels of glucose, lipids, and blood pressure postimplementation. In addition, completed optometry referrals increased by 44% and completed podiatry referrals increased by 60%. CONCLUSIONS Significant improvement in medical outcomes was found among patients of a behavioral health home who had comorbid diabetes and mental illness after introduction of a multicomponent care coordination intervention, regardless of which clinic they attended.
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Affiliation(s)
- Judith A. Cook
- University of Illinois at Chicago, Center on Mental Health Services Research and Policy, Chicago, IL
| | - Jessica A. Jonikas
- University of Illinois at Chicago, Center on Mental Health Services Research and Policy, Chicago, IL
| | - Pamela Steigman
- University of Illinois at Chicago, Center on Mental Health Services Research and Policy, Chicago, IL
| | - Crystal M. Glover
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
| | - Jane K. Burke-Miller
- University of Illinois at Chicago, Center on Mental Health Services Research and Policy, Chicago, IL
| | - Joni Weidenaar
- University of Illinois at Chicago, Center on Mental Health Services Research and Policy, Chicago, IL
| | | | | | - Asma Jami
- University of Minnesota Medical Center-Fairview, Department of Psychiatry and Behavioral Sciences, Minneapolis, MN
| | - Charles J. Santos
- Departments of Internal Medicine and Psychiatry, Tulane University School of Medicine, New Orleans, LA
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74
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Browne J, Cather C, Zvonar V, Thayer K, Skiest H, Arntz D, Kritikos K, Schnitzer K, Brown H, Evins AE, Donovan A. Developing a Sound Body: Open Trial Results of a Group Healthy Lifestyle Intervention for Young Adults with Psychosis. Community Ment Health J 2021; 57:864-871. [PMID: 32524260 DOI: 10.1007/s10597-020-00655-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
The mortality disparity for persons with schizophrenia spectrum disorders (SSDs) due to cardiovascular disease is a devastating problem. Many risk factors are present in young adults with psychosis that may be ameliorated with lifestyle interventions. Sixteen participants with SSDs enrolled in an 11-week open trial of a novel lifestyle intervention comprised of group high intensity interval training exercise and health and wellness education. The aims were to evaluate (1) feasibility and (2) impact on sedentary behavior, physical activity, nutritional knowledge, physiological outcomes, and psychological well-being at end of intervention and 11-week follow-up. Attendance rates were 70% or higher for both intervention components and participants reported increased learning about healthy eating and exercise habits. Moderate to large effect sizes were observed for physical activity and sedentary behavior with sustained improvements in sedentary behavior at follow-up. Meaningful changes were not observed in other domains.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. .,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Vanya Zvonar
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Thayer
- Department of Psychiatry, Mount Auburn Hospital, Cambridge, MA, USA
| | - Hannah Skiest
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Diana Arntz
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Katherine Kritikos
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kristina Schnitzer
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Hannah Brown
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - A Eden Evins
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Abigail Donovan
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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75
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Schnitzer K, Cather C. Individual- and System-Level Solutions for Promoting Integrated Medical Care for People with Serious Mental Illness in Public and Community Psychiatry. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210512-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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76
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Jonikas JA, Cook JA, Swarbrick M, Nemec P, Steigman PJ, Boss KA, Brice GH. The impact of the COVID-19 pandemic on the mental health and daily life of adults with behavioral health disorders. Transl Behav Med 2021; 11:1162-1171. [PMID: 33739399 PMCID: PMC8108632 DOI: 10.1093/tbm/ibab013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
People with behavioral health disorders may be particularly vulnerable to the impact of the COVID-19 pandemic, yet little is known about how they are faring. A mixed-methods, anonymous needs assessment was conducted to understand changes in the lives of adults with mental health and substance use disorders since the pandemic onset. A cross-sectional, online survey was completed by 272 adults in April and May 2020, recruited from statewide networks of community programs in New Jersey and New York. Measures included the Patient Health Questionnaire-2 and the Generalized Anxiety Disorder-2 to screen for depressive and anxiety disorders. Also assessed was the pandemic's impact on sleep and dietary patterns, exposure to COVID-19 infection, and access to health care and medications. Finally, respondents were asked to describe in their own words any changes in their lives since the pandemic began. Over one-third (35.1%) screened positive for generalized anxiety disorder and over one-quarter (29.6%) screened positive for major depressive disorder. The majority reported pandemic-related changes in eating and sleeping patterns and exposure to COVID-19 infection. Multivariable logistic regression analysis found that many changes attributed to the pandemic were positively and significantly associated with screening positive for anxiety and depressive disorders. Qualitative analysis confirmed these findings and identified participants' resilience stemming from social support, emotion management, and self-care. These results can inform the design of services that assist this population to bolster self-management skills and reestablish daily habits to improve their lives during and following the pandemic.
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Affiliation(s)
- Jessica A Jonikas
- Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
| | - Judith A Cook
- Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
| | - Margaret Swarbrick
- Wellness Institute, Collaborative Support Programs of New
Jersey, Freehold, NJ, USA
- Center of Alcohol and Substance Use Studies, Rutgers
University, Piscataway, NJ, USA
| | - Patricia Nemec
- Wellness Institute, Collaborative Support Programs of New
Jersey, Freehold, NJ, USA
| | - Pamela J Steigman
- Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
| | - Katherine A Boss
- Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
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77
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Suárez Benites CM, De La Cruz Vargas JA. Responsible prescription in Psychiatry: Metabolic Syndrome, an unresolved issue? ACTA ACUST UNITED AC 2021; 50:72-73. [PMID: 34099255 DOI: 10.1016/j.rcpeng.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
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78
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Lister J, Han L, Bellass S, Taylor J, Alderson SL, Doran T, Gilbody S, Hewitt C, Holt RIG, Jacobs R, Kitchen CEW, Prady SL, Radford J, Ride JR, Shiers D, Wang HI, Siddiqi N. Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background
People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap.
Objectives
The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness.
Design
Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews.
Setting
The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber).
Participants
The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff.
Data sources
The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation.
Results
People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’).
Limitations
Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices.
Conclusions
People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone.
Future work
These findings can inform the development of targeted interventions aimed at addressing inequalities in this population.
Study registration
National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921.
Funding
This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jennie Lister
- Department of Health Sciences, University of York, York, UK
| | - Lu Han
- Department of Health Sciences, University of York, York, UK
| | - Sue Bellass
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jo Taylor
- Department of Health Sciences, University of York, York, UK
| | - Sarah L Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | | - Richard IG Holt
- Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | | | | | - John Radford
- Patient and public involvement representative, Keighley, UK
| | - Jemimah R Ride
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Primary Care and Health Sciences, Keele University, Keele, UK
| | - Han-I Wang
- Department of Health Sciences, University of York, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
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Soberay A, Tolle LW, Kienitz E, Olson A. The Hope Health and Wellness Clinic: Outcomes of Individuals with Serious Mental Illness in a Bidirectional Integrated Care Clinic. Community Ment Health J 2021; 57:675-683. [PMID: 33125636 DOI: 10.1007/s10597-020-00730-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
The integrated health home, the Hope Health and Wellness Clinic, provides comprehensive primary and behavioral health services to adult clients of a Community Mental Health Center in Aurora, Colorado. A program evaluation of the effectiveness of this clinic was conducted over a 4 year period. Physical health data (Body Mass Index BMI, HbA1c, cholesterol, blood pressure, and waist circumference measurements) and self-report data (social connectedness, everyday functioning, psychological distress, perceived health, satisfaction with services) were tracked across time. Individuals enrolled (N = 534) experienced significant improvements over time in LDL and total cholesterol, as well as self-reported social connectedness, everyday functioning, perceived health, and psychological distress. At risk individuals demonstrated significant improvements in HDL cholesterol, triglycerides, blood pressure, tobacco and alcohol use. Individuals with serious mental illness show improvements in physical health and self-reported health after being involved in bidirectional integrated care.
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Affiliation(s)
- Adam Soberay
- Aurora Research Institute, 791 Chambers Road, Aurora, CO, USA
| | - Lauren Woodward Tolle
- University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Aurora, CO, 80045, USA.
| | - Eliza Kienitz
- Aurora Mental Health Center, 791 Chambers Rd Aurora, Aurora, CO, 80011, USA
| | - Amber Olson
- Aurora Mental Health Center, 791 Chambers Rd Aurora, Aurora, CO, 80011, USA
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80
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Stefancic A, Bochicchio L, Tuda D, Gurdak K, Cabassa LJ. Participant Experiences With a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness. Psychiatr Serv 2021; 72:530-538. [PMID: 33657839 PMCID: PMC8500678 DOI: 10.1176/appi.ps.202000311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the experiences of individuals with serious mental illness who were predominantly Black, were living in supportive housing, and participated in the Peer-Led Group Lifestyle Balance (PGLB) intervention. The authors examined how participants engaged in the process of behavior change and applied intervention concepts. METHODS Focus groups and interviews with 63 participants explored their motivation for engaging with PGLB, challenges to behavior change, and how they integrated intervention strategies into their lives. Interviews were transcribed and analyzed with grounded theory. RESULTS A grounded model summarized the description of the cycle of behavior change and provided insight into participants' decision-making processes. Challenges to engaging in healthy lifestyle change were related to participants' general medical health, time constraints, lack of knowledge, difficulties breaking old habits and changing self-perceptions, mood state, and the social-physical environment. Participants applied many intervention strategies, such as addressing problematic social cues, contexts, and food associations; planning ahead; starting with smaller changes; portion control; food substitution; mindful eating; and integrating changes into their daily lives. They reported various behavior changes with respect to eating and physical activity and more limited shifts in self-monitoring. CONCLUSIONS Improving the health of people with serious mental illness will require expanding their access to healthy lifestyle interventions in community-based settings. The findings suggest that future interventions should expand support for self-monitoring, meal planning, tailored physical activity, and advocacy. Such interventions should also enhance participants' understanding of the corresponding impact of changes on weight loss and emphasize subjective wellness outcomes to maintain motivation.
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Affiliation(s)
- Ana Stefancic
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Lauren Bochicchio
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Daniela Tuda
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Kristen Gurdak
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Leopoldo J Cabassa
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
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Cabassa LJ, Stefancic A, Lewis-Fernández R, Luchsinger J, Weinstein LC, Guo S, Palinkas L, Bochicchio L, Wang X, O'Hara K, Blady M, Simiriglia C, Medina McCurdy M. Main Outcomes of a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness in Supportive Housing. Psychiatr Serv 2021; 72:555-562. [PMID: 33334158 PMCID: PMC8607694 DOI: 10.1176/appi.ps.202000304] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The effectiveness of the Peer-led Group Lifestyle Balance (PGLB) intervention, a 12-month manualized healthy lifestyle intervention delivered by peer specialists, was investigated in a sample of persons with serious mental illness who were overweight or obese and living in supportive housing. METHODS The authors randomly assigned 314 participants from three supportive housing agencies to PGLB or usual care, with assessments at baseline and 6, 12, and 18 months. Outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of ≥50 meters in the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS Most participants were from racial-ethnic minority groups (82%, N=255). The mean±SD baseline weight of this sample was 218.8±54.0 pounds, and the body mass index was 33.7±7.2. Compared with the usual care group, a larger proportion of the PGLB group achieved clinically significant changes in study outcomes at 12 and 18 months, but none of these changes was statistically significant. Outcomes differed by site: two sites reported no significant differences between the two groups, and one reported that PGLB significantly outperformed usual care on clinically significant weight loss at 18 months and CVD risk reduction at 6 and 12 months. CONCLUSIONS The null findings indicate that PGLB was not superior to usual care in helping participants achieve clinically significant changes in weight, CRF, and CVD risk reduction at 12 and 18 months. Questions remain regarding how PGLB works, for whom, and in which settings.
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Affiliation(s)
- Leopoldo J Cabassa
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Ana Stefancic
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Roberto Lewis-Fernández
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - José Luchsinger
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lara Carson Weinstein
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Shenyang Guo
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lawrence Palinkas
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lauren Bochicchio
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Xiaoyan Wang
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Kathleen O'Hara
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Michael Blady
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Christine Simiriglia
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Monica Medina McCurdy
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
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Gallagher P, Boland C, McClenaghan A, Fanning F, Lawlor E, Clarke M. Improved self-esteem and activity levels following a 12-week community activity and healthy lifestyle programme in those with serious mental illness: A feasibility study. Early Interv Psychiatry 2021; 15:367-373. [PMID: 32337860 DOI: 10.1111/eip.12965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 02/25/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Those with serious mental illness (SMI) including both psychotic and affective disorders are recognized to have a premature mortality compared to the general population, at least in part due to elevated cardiovascular risk profile. AIM To examine the effect of a 12-week, pragmatic, sustainable, low-cost intervention involving community activity, nutritional advice and exercise that could be accessible to patients attending a community clinic. METHODS Participants (N = 35) with SMI attending a community mental health service who were considered at risk of metabolic syndrome were referred by their clinical teams to a specialized healthy activity and nutritional programme. The intervention involved participation in exercise, dietary education and targeted lifestyle advice focused on community activities. Data on physical health and clinical parameters were collected pre- and post-intervention. RESULTS Physical activity increased following the intervention along with a statistically significant increase in self-esteem scores. There was no significant reduction in body mass index or lowering of anxiety and depression scores. CONCLUSIONS It is feasible to develop a relatively low-cost, community-based physical activity programme, integrating both nutritional advice and healthy activities. This may lead to improved outcomes in cardiovascular risk profile and improved life expectancy.
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Affiliation(s)
- Peter Gallagher
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Cailín Boland
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Aisling McClenaghan
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Felicity Fanning
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Elizabeth Lawlor
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Mary Clarke
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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83
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Shahid A, Nguyen TAN, Kechadi MT. Big Data Warehouse for Healthcare-Sensitive Data Applications. SENSORS 2021; 21:s21072353. [PMID: 33800574 PMCID: PMC8037603 DOI: 10.3390/s21072353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 01/22/2023]
Abstract
Obesity is a major public health problem worldwide, and the prevalence of childhood obesity is of particular concern. Effective interventions for preventing and treating childhood obesity aim to change behaviour and exposure at the individual, community, and societal levels. However, monitoring and evaluating such changes is very challenging. The EU Horizon 2020 project "Big Data against Childhood Obesity (BigO)" aims at gathering large-scale data from a large number of children using different sensor technologies to create comprehensive obesity prevalence models for data-driven predictions about specific policies on a community. It further provides real-time monitoring of the population responses, supported by meaningful real-time data analysis and visualisations. Since BigO involves monitoring and storing of personal data related to the behaviours of a potentially vulnerable population, the data representation, security, and access control are crucial. In this paper, we briefly present the BigO system architecture and focus on the necessary components of the system that deals with data access control, storage, anonymisation, and the corresponding interfaces with the rest of the system. We propose a three-layered data warehouse architecture: The back-end layer consists of a database management system for data collection, de-identification, and anonymisation of the original datasets. The role-based permissions and secured views are implemented in the access control layer. Lastly, the controller layer regulates the data access protocols for any data access and data analysis. We further present the data representation methods and the storage models considering the privacy and security mechanisms. The data privacy and security plans are devised based on the types of collected personal, the types of users, data storage, data transmission, and data analysis. We discuss in detail the challenges of privacy protection in this large distributed data-driven application and implement novel privacy-aware data analysis protocols to ensure that the proposed models guarantee the privacy and security of datasets. Finally, we present the BigO system architecture and its implementation that integrates privacy-aware protocols.
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84
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Cheung A, Cui Z, Hamada K, Selland J, Chiang M, Fan X. Walking together: Exploring perspectives, attitudes, and barriers on nutrition and exercise among individuals with serious mental illness. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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85
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Browne J, Battaglini C, Jarskog LF, Sheeran P, Abrantes AM, McDermott J, Elliott T, Gonzalez O, Penn DL. Targeting Physical Health in Schizophrenia: Results from the Physical Activity Can Enhance Life (PACE-Life) 24-Week Open Trial. Ment Health Phys Act 2021; 20:100393. [PMID: 34178113 PMCID: PMC8224902 DOI: 10.1016/j.mhpa.2021.100393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Poor health and low cardiorespiratory fitness (CRF) contribute substantially to the shortened lifespan of individuals with schizophrenia spectrum disorders (SSDs). Increasing physical activity has demonstrated value; however, there are limited interventions that are accessible and adequately address motivational challenges. This paper reports on an open trial of Physical Activity Can Enhance Life (PACE-Life), a motivational theory-based manualized multicomponent walking intervention. The primary aim was to examine the feasibility of implementing PACE-Life through meeting the recruitment target (n=14), attendance and adherence rates, and participant feedback. The secondary aim was to assess the impact of PACE-Life on intermediate targets (autonomous motivation and satisfaction of autonomy, relatedness, and competence needs), proximal outcomes (Fitbit steps/day and minutes spent walking), the primary outcome (CRF), and secondary outcomes (loneliness, symptoms, resting heart rate, blood pressure, weight, body mass index, and hip and waist circumference). Seventeen participants with SSDs enrolled in a 24-week open trial. Assessments occurred at baseline, midpoint, post-test, and one-month follow-up. The recruitment target was exceeded, the group attendance rate was 34%, Fitbit adherence rate was 54%, and participant feedback indicated satisfaction with the intervention as well as a positive group environment. There was a large improvement in the primary outcome of CRF with 77% of participants achieving clinically significant improvement at post-test. Small and medium effect size increases were observed in autonomous motivation and satisfaction of autonomy, relatedness, and competence needs. Fitbit data and secondary outcomes generally remained unchanged or worsened during the intervention. Results from this open trial indicate that PACE-Life leads to meaningful changes in CRF among people with SSDs.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Claudio Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L. Fredrik Jarskog
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jessica McDermott
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tonya Elliott
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Oscar Gonzalez
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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86
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Goodsmith N, Cohen AN, Flynn AWP, Hamilton AB, Hellemann G, Nowlin-Finch N, Young AS. Computerized Conjoint Analysis of the Weight Treatment Preferences of Individuals With Schizophrenia. Psychiatr Serv 2021; 72:288-294. [PMID: 33430650 PMCID: PMC7920898 DOI: 10.1176/appi.ps.202000068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Innovative approaches are needed for assessing treatment preferences of individuals with schizophrenia. Conjoint analysis methods may help to identify preferences, but the usability and validity of these methods for individuals with schizophrenia remain unclear. This study examined computerized conjoint analysis for persons with schizophrenia and whether preferences for weight management programs predict service use. METHODS A computerized, patient-facing conjoint analysis system was developed through iterative consultation with 35 individuals with schizophrenia enrolled at a community mental health clinic. An additional 35 overweight participants with schizophrenia then used the system to choose among psychosocial weight management programs varying in four attributes: location (community or clinic), delivery mode (Internet or in person), leader (clinician or layperson), and training mode (individual or group). A multilevel logit model with partial preference data determined contributions of each attribute to groupwide preferences. Associations were studied between preferences and use of a psychosocial weight management group. RESULTS Conjoint analysis system usability was rated highly. Groupwide preferences were significantly influenced by location (p<0.001; clinic was preferred), leader (p=0.02; clinician was preferred), and training mode (p<0.001; group was preferred) but not delivery mode (p=0.68). Preferences did not correlate with age, gender, body mass index, illness severity, or subsequent program use. Participants described barriers to program attendance, including transportation, scheduling, privacy, psychiatric illness, and lack of motivation. CONCLUSIONS Computerized conjoint analysis can produce valid assessments of treatment preferences of persons with schizophrenia and inform treatment development and implementation. Although preferences may affect treatment use, they are one of multiple factors.
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Affiliation(s)
- Nichole Goodsmith
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Amy N Cohen
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Anthony W P Flynn
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Alison B Hamilton
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Gerhard Hellemann
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Nancy Nowlin-Finch
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
| | - Alexander S Young
- Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy, Health Services Research and Development Service, VA Greater Los Angeles Healthcare System, Los Angeles (Goodsmith, Hamilton); National Clinician Scholars Program, University of California, Los Angeles (UCLA), Los Angeles (Goodsmith); VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (Goodsmith, Young); American Psychiatric Association (Cohen); Department of Counseling Psychology, University of Wisconsin-Madison, Madison (Flynn); Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles (Hamilton, Hellemann, Nowlin-Finch, Young); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch)
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Schnitzer K, Cather C, Zvonar V, Dechert A, Plummer R, Lowman K, Pachas G, Potter K, Evins AE. Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study. J Particip Med 2021; 13:e21934. [PMID: 33576747 PMCID: PMC7910121 DOI: 10.2196/21934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/12/2020] [Accepted: 12/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In a previous study, participation in a 16-week reverse integrated care and group behavioral and educational intervention for individuals with diabetes and serious mental illness was associated with improved glycemic control (hemoglobin A1c) and BMI. To inform future implementation efforts, more information about the effective components of the intervention is needed. OBJECTIVE The goal of this study is to identify the aspects of the intervention participants reported to be helpful and to evaluate the predictors of outcomes. METHODS This study involved qualitative evaluation and post hoc quantitative analysis of a previous intervention. Qualitative data were collected using semistructured interviews with 69% (24/35) of the individuals who attended 1 or more group sessions and 35% (9/26) of the individuals who consented but attended no sessions. Quantitative mixed effects modeling was performed to test whether improved diabetes knowledge, diet, and exercise or higher group attendance predicted improved hemoglobin A1c and BMI. These interview and modeling outcomes were combined using a mixed methods case study framework and integrated thematically. RESULTS In qualitative interviews, participants identified the application of health-related knowledge gained to real-world situations, accountability for goals, positive reinforcement and group support, and increased confidence in prioritizing health goals as factors contributing to the success of the behavioral intervention. Improved knowledge of diabetes was associated with reduced BMI (β=-1.27, SD 0.40; P=.003). No quantitative variables examined were significantly associated with improved hemoglobin A1c levels. CONCLUSIONS In this mixed methods analysis of predictors of success in a behavioral diabetes management program, group participants highlighted the value of positive reinforcement and group support, accountability for goals set, and real-world application of health-related knowledge gained. Improved diabetes knowledge was associated with weight loss.
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Affiliation(s)
- Kristina Schnitzer
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Corrine Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States.,Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Vanya Zvonar
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States.,Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Alyson Dechert
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Rachel Plummer
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Kelsey Lowman
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Gladys Pachas
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Kevin Potter
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States
| | - Anne Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
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88
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Orleans-Pobee M, Browne J, Ludwig K, Merritt C, Battaglini CL, Jarskog LF, Sheeran P, Penn DL. Physical Activity Can Enhance Life (PACE-Life): results from a 10-week walking intervention for individuals with schizophrenia spectrum disorders. J Ment Health 2021; 31:357-365. [PMID: 33527859 DOI: 10.1080/09638237.2021.1875403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Premature mortality in individuals with schizophrenia spectrum disorders (SSDs) is largely due to high rates of chronic health conditions. Although exercise has been shown to improve health in this population, scalable and accessible interventions are limited. AIM To examine the impact of Physical Activity Can Enhance Life (PACE-Life), a novel walking intervention, on physical activity, and on secondary outcomes of cardiorespiratory fitness (CRF), physical health, autonomous motivation, social support, and quality of life. METHOD Sixteen individuals with SSDs were enrolled in a 10-week open trial. The intervention included walking groups, home-based walks, Fitbit use, and goal-setting and if-then plans. Within-group effect sizes were calculated to represent changes from baseline to post-test and 1-month follow-up. RESULTS Participants increased self-reported weekly walking minutes and decreased daily hours spent sitting; however, Fitbit-recorded exercise behavior changed only minimally. There were also improvements in secondary outcomes including autonomous motivation and hip circumference. CRF improved only minimally, and findings were relatively unchanged with outliers removed from the full sample. CONCLUSIONS This open trial demonstrates modest improvements in key parameters of exercise behavior and physical health from participating in PACE-Life. Future research should assess the efficacy of this intervention in a randomized controlled trial.
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Affiliation(s)
- Maku Orleans-Pobee
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelsey Ludwig
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carrington Merritt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claudio L Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L Fredrik Jarskog
- Department of Psychiatry, University of North Carolina School of Medicine, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
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89
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McGinty EE, Murphy KA, Dalcin AT, Stuart EA, Wang NY, Dickerson F, Gudzune K, Jerome G, Thompson D, Cullen BA, Gennusa J, Kilbourne AM, Daumit GL. A Model for Advancing Scale-Up of Complex Interventions for Vulnerable Populations: the ALACRITY Center for Health and Longevity in Mental Illness. J Gen Intern Med 2021; 36:500-505. [PMID: 32869192 PMCID: PMC7878664 DOI: 10.1007/s11606-020-06137-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
Many of the most pressing health issues in the USA and worldwide require complex, multi-faceted solutions. Delivery of such solutions is often complicated by the need to reach and engage vulnerable populations facing multiple barriers to care. While the fields of quality improvement and implementation science have made valuable gains in the development and spread of individual strategies to improve evidence-based practice delivery, models for coordinated deployment of numerous strategies to simultaneously implement multiple evidence-based interventions in vulnerable populations are lacking. In this Perspective, we describe a model for this type of comprehensive research-practice translation effort: the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness, which is focused on reducing premature mortality in the population with serious mental illness. We describe the Center's conceptual framework, which is built upon an integrated set of quality improvement and implementation science frameworks, provide an overview of the Center's organizational structure and core research-practice translation activities, and discuss our vision for how the Center may evolve over time. Lessons learned from this Center's efforts could inform models to address other critical health issues in vulnerable populations that require multi-component solutions at the policy, system, provider, and patient levels.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Karly A Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Arlene T Dalcin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kim Gudzune
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gerald Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA
| | - David Thompson
- Department of Anesthesiology and Critical Care and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bernadette A Cullen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amy M Kilbourne
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MD, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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90
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"Being There" vs "Being Direct:" Perspectives of Persons with Serious Mental Illness on Receiving Support with Physical Health from Peer and Non-Peer Providers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:539-550. [PMID: 33479782 DOI: 10.1007/s10488-020-01098-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
Individuals with serious mental illness (SMI) face significant health disparities and multiple barriers to engaging in health behavior change. To reduce these health disparities, it is necessary to enhance the support individuals with SMI receive through the collaboration of different healthcare providers. This study explored how people with SMI living in supportive housing perceived receiving support from peer and non-peer providers for their physical health. Qualitative interviews were conducted with 28 participants receiving a peer-led healthy lifestyle intervention in the context of a randomized trial in supportive housing agencies. Interviews explored participants' experiences working with the healthy lifestyle peer specialist and a non-peer provider who assisted them with health. Interviews were audio recorded, transcribed, and analyzed using strategies rooted in grounded theory. Participants viewed their relationships with peer and non-peer providers positively, but described differences in the approach to practice, power dynamics present, and how they identified with each provider. Participants described peers as process-oriented while non-peer staff as task-oriented, focusing on accomplishing concrete objectives. Each provider sought to boost participants' motivation, but peers built hope by emphasizing the possibility of change, while non-peer providers emphasized the consequences of inaction. Participants related to peer staff through shared experiences, while identifying the importance of having a shared treatment goal with their non-peer provider. Overall, participants appreciated the unique roles of both peer and non-peer staff in supporting their health. Study findings have implications for integrating the use of peer-based health interventions to improve the health of people with SMI.
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91
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Martens N, Destoop M, Dom G. Organization of Community Mental Health Services for Persons with a Severe Mental Illness and Comorbid Somatic Conditions: A Systematic Review on Somatic Outcomes and Health Related Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E462. [PMID: 33435525 PMCID: PMC7826863 DOI: 10.3390/ijerph18020462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 12/20/2022]
Abstract
It is well established that persons with a severe mental illness (SMI) have a greater risk of physical comorbid conditions and premature mortality. Most studies in the field of community mental health care (CMHC) have only focused on improving cardiovascular health in people with a SMI using lifestyle approaches. Studies using organizational modifications are rather scarce. This systematic review aimed to synthesize and describe possible organizational strategies to improve physical health for persons with a SMI in CMHC. The primary outcome was Health-related Quality of Life (HR-QOL). Results suggested modest effects on quality of life and were inconsistent throughout all the included studies. Despite these findings, it appears that a more integrated approach had a positive effect on health outcomes, patient satisfaction and HR-QOL. The complexity of the processes involved in community care delivery makes it difficult to compare different models and organizational approaches. Mental health nurses were identified as possible key professionals in care organization, but no clear description of their role was found. This review could provide new insights into contributing factors for integrated care. Future research targeting the identification of the nurses' role and facilitating factors in integrated care, in order to improve treatment and follow-up of somatic comorbidities, is recommended.
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Affiliation(s)
- Nicolaas Martens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
- Department of Health and Welfare, Karel De Grote University College, B-2018 Antwerp, Belgium
| | - Marianne Destoop
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
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92
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Lupton-Smith C, Stuart EA, McGinty EE, Dalcin AT, Jerome GJ, Wang NY, Daumit GL. Determining Predictors of Weight Loss in a Behavioral Intervention: A Case Study in the Use of Lasso Regression. Front Psychiatry 2021; 12:707707. [PMID: 35185628 PMCID: PMC8850776 DOI: 10.3389/fpsyt.2021.707707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/29/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE This study investigates predictors of weight loss among individuals with serious mental illness participating in an 18-month behavioral weight loss intervention, using Lasso regression to select the most powerful predictors. METHODS Data were analyzed from the intervention group of the ACHIEVE trial, an 18-month behavioral weight loss intervention in adults with serious mental illness. Lasso regression was employed to identify predictors of at least five-pound weight loss across the intervention time span. Once predictors were identified, classification trees were created to show examples of how to classify participants into having likely outcomes based on characteristics at baseline and during the intervention. RESULTS The analyzed sample contained 137 participants. Seventy-one (51.8%) individuals had a net weight loss of at least five pounds from baseline to 18 months. The Lasso regression selected weight loss from baseline to 6 months as a primary predictor of at least five pound 18-month weight loss, with a standardized coefficient of 0.51 (95% CI: -0.37, 1.40). Three other variables were also selected in the regression but added minimal predictive ability. CONCLUSIONS The analyses in this paper demonstrate the importance of tracking weight loss incrementally during an intervention as an indicator for overall weight loss, as well as the challenges in predicting long-term weight loss with other variables commonly available in clinical trials. The methods used in this paper also exemplify how to effectively analyze a clinical trial dataset containing many variables and identify factors related to desired outcomes.
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Affiliation(s)
- Carly Lupton-Smith
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth A Stuart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma E McGinty
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Arlene T Dalcin
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States
| | - Nae-Yuh Wang
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gail L Daumit
- Johns Hopkins School of Medicine, Baltimore, MD, United States
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93
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"Looking Forward": a qualitative evaluation of a physical activity program for middle-aged and older adults with serious mental illness. Int Psychogeriatr 2020; 32:1449-1456. [PMID: 31455434 PMCID: PMC7047554 DOI: 10.1017/s1041610218002004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Older adults with serious mental illness (SMI) often have poor physical health in addition to serious mental health issues. Sustained engagement in a group physical activity program may provide necessary physical and mental health benefits. The purpose of this report is to describe participants' feedback about a video game-based group physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA). In particular, we wanted to understand what worked about the program, what was not ideal, and how it impacted their lives. DESIGN Semi-structured interviews were collected and analyzed with grounded theory methodology. SETTING Mental health facility. PARTICIPANTS Sixteen older adults with SMI. MEASUREMENTS Participants played an active video game for 50-minute sessions, three times a week for 10 weeks. Qualitative interviews were conducted with 16 participants upon completion of the program. RESULTS Participants expressed enthusiasm for the physical activity program, indicating it was an activity that they looked forward to doing. The results of the study provide insight into how the program may be implemented into practice at mental health facilities. Three implementation to practice categories were identified: (1) programmatic considerations, such as when to hold the groups and where; (2) the critical importance of staff involvement; and (3) harnessing patients' interest in the program. CONCLUSION Our results suggest that engagement in an intense video game-based group physical activity program has a positive impact on participants' overall health. The group atmosphere, staff involvement, availability of the program at a mental health facility, and health benefits were critical.
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94
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Khullar D, Zhang Y, Kaushal R. Potentially Preventable Spending Among High-Cost Medicare Patients: Implications for Healthcare Delivery. J Gen Intern Med 2020; 35:2845-2852. [PMID: 32103440 PMCID: PMC7573047 DOI: 10.1007/s11606-020-05691-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/08/2019] [Accepted: 01/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND High-cost patients account for a disproportionate share of healthcare spending. The proportion and distribution of potentially preventable spending among subgroups of high-cost patients are largely unknown. OBJECTIVE To examine the distribution of potentially preventable spending among high-cost Medicare patients overall and potentially preventable spending associated with each high-cost category. DESIGN A cross-sectional study. We merged Medicare claims and social determinants of health data to group patients into high-cost categories and quantify potentially preventable spending. PATIENTS A total of 556,053 Medicare fee-for-service and dual-eligible beneficiaries with at least one healthcare encounter in the New York metropolitan area in 2014. MAIN MEASURES High-cost patients were mapped into 10 non-mutually exclusive categories. The primary outcome was episodic spending associated with preventable ED visits, preventable hospitalizations, and unplanned 30-day readmissions. KEY RESULTS Overall, potentially preventable spending accounted for 10.4% of overall spending in 2014. Preventable spending accounted for 13.3% of total spending among high-cost patients and 4.9% among non-high-cost patients (P < 0.001). Among high-cost patients, 44.0% experienced at least one potentially preventable encounter compared with 11.4% of non-high-cost patients (P < 0.001), and high-cost patients accounted for 71.5% of total preventable spending. High-cost patients had on average $11,502 in potentially preventable spending-more than 20 times more than non-high-cost patients ($510). High-cost patients in the seriously ill, frail, or serious mental illness categories accounted for the highest proportion of potentially preventable spending overall, while end-stage renal disease, serious illness, and opioid use disorder were associated with the highest preventable spending per patient. CONCLUSION Potentially preventable spending was concentrated among high-cost patients who were seriously ill, frail, or had a serious mental illness. Interventions targeting these subgroups may be helpful for reducing preventable utilization.
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Affiliation(s)
- Dhruv Khullar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA.
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- NewYork-Presbyterian Hospital, New York, NY, USA.
| | - Yongkang Zhang
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Rainu Kaushal
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
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95
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Watkins A, Stein-Parbury J, Denney-Wilson E, Ward PB, Rosenbaum S. Upskilling Mental Health Nurses to Address the Burden of Poor Metabolic Health: A Mixed Method Evaluation. Issues Ment Health Nurs 2020; 41:925-931. [PMID: 32552212 DOI: 10.1080/01612840.2020.1744204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
People living with a severe mental illness experience a life expectancy gap compared to the rest of the population that is largely driven by preventable cardiovascular diseases stemming from lifestyle factors, and the side effects of psychotropic medications. Mental health nurses are well positioned to help address the gap using lifestyle interventions. However, many nurses don't prioritise delivering such care, or lack the skills and confidence to implement these strategies. This study used a mixed method approach to determine the effectiveness of 2-day metabolic workshops that aimed to provide nurses with the skills to provide lifestyle interventions. The quantitative component compares pre and post measures of attitudes, confidence, knowledge and perceived barriers of providing metabolic care using a validated tool (M-BACK) and the qualitative component to elicit more details of the needs, expectations and plans of participants. Fifty-six nurse participants demonstrated statistically significant improvements in M-BACK post scores (p < 0.001), with 53 of the 56 participants (95%) achieving improved M-BACK scores. Participants identified three primary barriers to delivering metabolic care, related to individual staff members, consumers, and system issues. Prior to the course participants stated they hoped to improve their knowledge, enhance their practical skills and provide education for others. Following completion of the course participants planned to implement lifestyle education and interventions for consumers, provide education and support to other staff and integrate metabolic health care into clinical reviews and planning. This study demonstrates that education on metabolic health care can be effective in improving the attitudes, confidence, and knowledge of mental health nursing in providing metabolic health care and a decrease in the perceived barriers to delivering that care.
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Affiliation(s)
- Andrew Watkins
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of Sunshine Coast, Birtinya, Queensland, Australia.,Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | | | - Philip B Ward
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia.,Liverpool Hospital, Schizophrenia Research Unit, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
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96
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Matthews EB, Bond L, Stanhope V. Understanding Health Talk in Behavioral Health Encounters: A Qualitative Analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:551-563. [PMID: 32964333 DOI: 10.1007/s10488-020-01088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Abstract
Although physical and behavioral health conditions commonly cooccur, best practices making behavioral health treatment responsive to clients' health needs are limited. Particularly little is known about how physical health is addressed by clinicians within routine therapeutic treatment. This study describes the frequency and type of health talk occurring within integrated behavioral health sessions, and explores how this talk functions within ongoing therapeutic work. Participants in this study included 51 dyads of clinical social workers (n = 13) and clients (n = 51) receiving therapy within an integrated community health and behavioral health center. Therapy sessions were recorded and transcribed verbatim. Content analysis determined the frequency and content of health talk in sessions. Thematic analysis was used to understand the function of health talk within these visits. Health talk occurred in 92% (n = 47) of sessions. Clients initiated the majority of discussions. Talk about sleep (40%, n = 19), diet/exercise (35%, n = 16), and chronic health conditions (28%, n = 13) were most common. Health talk either complimented or conflicted with therapeutic work, depending on the topic discussed and when it occurred during session. Health talk changed the scope of therapeutic work by integrating care coordination into routine practice. Health talk was pervasive and was frequently initiated by clients, signaling its relevance to clients' recovery. Providers leveraged heath talk to complement their therapeutic work, but these strategies were not universally applied. Care coordination activities were a part of routine therapy. Practice and policy changes that support a more interdisciplinary approach to clinical work are needed.
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Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, 113 W 60th St, New York, NY, 10023, USA.
| | - Lynden Bond
- New York University Silver School of Social Work, 1 Washington Plaza, New York, NY, 10003, USA
| | - Victoria Stanhope
- New York University Silver School of Social Work, 1 Washington Plaza, New York, NY, 10003, USA
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97
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Evans-Hudnall G, Odafe MO, Johnson A, Armenti N, O'Neil J, Lawson E, Trahan LH, Rassu FS. Using an Adjunctive Treatment to Address Psychological Distress in a National Weight Management Program: Results of an Integrated Pilot Study. Mil Med 2020; 185:e1662-e1670. [PMID: 32728734 DOI: 10.1093/milmed/usaa145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Obesity is highly comorbid with psychological symptoms in veterans, particularly post-traumatic stress disorder (PTSD), depression, and anxiety. Obese veterans with comorbid psychological symptoms often display suboptimal weight loss and poor physical functioning when participating in weight management programs. The MOVE! program aims to increase healthy eating and physical activity to promote weight loss in obese veterans. Adequately addressing psychological barriers is necessary to maximize outcomes in MOVE! for veterans with PTSD, depression, and anxiety. We examined the preliminary outcomes of administering the Healthy Emotions and Improving Health BehavioR Outcomes (HERO) intervention. HERO is adjunctive cognitive-behavioral therapy to MOVE! that addresses PTSD, depression, and anxiety symptom barriers to engagement in physical activity. MATERIALS AND METHODS All recruitment and study procedures were approved by the institutional review board and research and development committees of the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston, Texas. Participants gave written informed consent before enrollment. Thirty-four obese veterans with a diagnosis of PTSD, depression, and/or anxiety who were attending MOVE! were assigned to the 8-session HERO group or the usual care (UC) group. Veterans completed assessments of PTSD, depression and anxiety symptoms, physical activity, physical functioning, and weight at baseline, 8 and 16 weeks post treatment. Changes from baseline to 8- and 16-week follow-up on the self-report and clinician-rated measures were assessed, using independent samples t-tests and analyses of covariance. RESULTS At 8 weeks post treatment, participants in the HERO group had significantly higher step counts per day than participants in the UC group. Similarly, at 16 weeks post-treatment, participants in the HERO group continued to experience a significant increase in daily steps taken per day, as well as statistically and clinically significantly lower scores on the depression symptom and PTSD symptom severity. Participants in the HERO group also demonstrated significantly higher scores on the physical functioning inventory than participants in the UC group (44.1 ± 12.1 vs. 35.7 ± 10.7, P = 0.04) at 16 weeks post treatment. CONCLUSIONS Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. Providing an adjunctive treatment to MOVE! that addresses psychological distress has potential benefits for psychological symptom reduction, engagement in healthy dietary habits, and greater physical activity for individuals who traditionally experience barriers to making positive weight management changes.
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Affiliation(s)
- Gina Evans-Hudnall
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030.,VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center)
| | - Mary O Odafe
- Department of Clinical Psychology, University of Houston, Heyne building # 126, Houston, TX 77204
| | - Adrienne Johnson
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705.,University of Wisconsin Center for Tobacco Research and Intervention, 1930 Monroe St., #200, Madison, WI 53711
| | - Nicholas Armenti
- Department of Clinical Psychology, University of Houston, Heyne building # 126, Houston, TX 77204
| | - Jennifer O'Neil
- Department of Psychiatry and Behavioral Medicine, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030
| | - Evan Lawson
- Department of Counseling Psychology, University of North Texas, 1155 Union Circle #311280, Denton, Texas 76203-5017
| | - Lisa H Trahan
- Trahan Counseling, 631 Mill Street, Suite 101 San Marcos, Texas 78666
| | - Fenan S Rassu
- Department of Psychiatry and Behavioral Medicine, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030
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98
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Shukla AP, Mandel LS, Tchang BG, Litman E, Cadwell J, Kumar RB, Waitman J, Igel LI, Christos P, Aronne LJ. Medical Weight-Loss Outcomes in Patients Receiving Concomitant Psychotropic Medication: A Retrospective Cohort Study. Obesity (Silver Spring) 2020; 28:1671-1677. [PMID: 32776501 DOI: 10.1002/oby.22903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed to elucidate medical weight-loss outcomes in patients unexposed or exposed to psychotropic medication(s). METHODS This retrospective cohort study evaluated weight-loss outcomes of completers treated at an academic weight-management center between April 1, 2014, and April 1, 2016. Patients were classified as either unexposed (not prescribed psychotropic medication) or exposed (prescribed psychotropic medication) based on use of antidepressants, mood stabilizers, or antipsychotics during the study. RESULTS Of 1,932 patients seen during the study period, 885 were eligible for inclusion, of whom 619 (70.0%) were unexposed and 266 (30.0%) were exposed to psychotropic medications. In the unexposed and exposed groups, the mean age, sex distribution, proportion with type 2 diabetes, initial BMI, and number of weight-loss medications prescribed were similar. At 12 months, the unexposed group lost 1.6% more weight on average than the exposed group (9.1% [SD 7.6%] vs. 7.5% [SD 8.1%], respectively; P = 0.02); 71.0% and 41.2% of the unexposed group achieved ≥ 5% and ≥ 10% weight loss at 12 months, respectively, compared with 63.1% and 31.8% in the exposed group at 12 months (P = 0.04 at 5%; P = 0.02 at 10%). CONCLUSIONS Exposure to psychotropic medications was associated with diminished weight loss in patients with medically managed overweight and obesity.
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Affiliation(s)
- Alpana P Shukla
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Lindsay S Mandel
- Department of Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Beverly G Tchang
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Ethan Litman
- Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, USA
| | - Joshua Cadwell
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rekha B Kumar
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jonathan Waitman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Leon I Igel
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Paul Christos
- Department of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York, USA
| | - Louis J Aronne
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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99
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Sá Filho AS, Cheniaux E, de Paula CC, Murillo-Rodriguez E, Teixeira D, Monteiro D, Cid L, Yamamoto T, Telles-Correia D, Imperatori C, Budde H, Machado S. Exercise is medicine: a new perspective for health promotion in bipolar disorder. Expert Rev Neurother 2020; 20:1099-1107. [PMID: 32762382 DOI: 10.1080/14737175.2020.1807329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Similar effects in reducing the symptoms of the mood disorder are reported in the literature compared the action of drugs and aerobic exercise sessions, demonstrating the potential of exercise in the control and mood stabilization. Therefore, there are many reasons to believe that the increased cardiorespiratory fitness (VO2max) can be an important means of protection and a reducing potential of physical and mental damage in bipolar disorders (BD). This review will highlight the current pattern of response of exercise on the pathophysiology of BD, relating the possible mechanisms, and hypotheses based on exercises. AREAS COVERED The mechanism of monoaminergic action and its relationship with exercise, role of physical conditioning and increased VO2Max on neurotrophin release, and new perspectives on long-term exercise will be reviewed. EXPERT OPINION The adaptations to training, although little explored in the context of BD, can induce the expression of substances that co-regulate several processes related to the pathophysiology of BD. Furthermore, high intensity interval training (HIIT) can also be adjusted to improve the physical fitness and health in patients with BD. Future research is needed to adopt a training strategy that is both time efficient and adequate for the population in question.
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Affiliation(s)
- Alberto Souza Sá Filho
- Department of Physical Education, Paulista University (UNIP) , São Paulo, Brazil.,Department of Physical Education, University Center of Anápolis (Unievangélica) , Anápolis, Brazil
| | - Elie Cheniaux
- School of Medical Sciences, State University of Rio De Janeiro (UERJ) , Rio De Janeiro, Brazil.,Institute of Psychiatry, Federal University of Rio De Janeiro , Rio De Janeiro, Brazil
| | - Carolina Cavalcante de Paula
- Department of Cellular, Tissue and Developmental Biology, The Institute of Biomedical Science, The University of São Paulo (ICB/USP) , São Paulo, Brazil
| | - Eric Murillo-Rodriguez
- International Neuroscience Research Group , Yucatan, México.,Laboratorio De Neurociencias Moleculares E Integrativas, Escuela De Medicina, División Ciencias De La Salud, Universidad Anáhuac Mayab , Mérida, Mexico
| | - Diogo Teixeira
- International Neuroscience Research Group , Yucatan, México.,Faculty of Physical Education and Sport, ULHT , Lisbon, Portugal
| | - Diogo Monteiro
- International Neuroscience Research Group , Yucatan, México.,Research Centre in Sports, Health and Human Development, CIDESD , Rio Maior, Portugal.,Sport Science School of Rio Maior, Polytechnique Institute of Santarém , Rio Maior, Portugal
| | - Luis Cid
- International Neuroscience Research Group , Yucatan, México.,Research Centre in Sports, Health and Human Development, CIDESD , Rio Maior, Portugal.,Sport Science School of Rio Maior, Polytechnique Institute of Santarém , Rio Maior, Portugal
| | - Tetsuya Yamamoto
- International Neuroscience Research Group , Yucatan, México.,Graduate School of Technology, Industrial and Social Sciences, Tokushima University , Tokushima, Japan
| | - Diogo Telles-Correia
- International Neuroscience Research Group , Yucatan, México.,Clínica Universitária De Psicologia E Psiquiatria, Faculdade De Medicina, Universidade De Lisboa , Lisbon, Portugal.,Departamento De Psiquiatria, Faculdade De Medicina, Universidade De Lisboa , Lisbon, Portugal
| | - Claudio Imperatori
- International Neuroscience Research Group , Yucatan, México.,Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190 , Rome, Italy
| | - Henning Budde
- International Neuroscience Research Group , Yucatan, México.,Faculty of Human Sciences, Medical School Hamburg, University of Applied Science and Medical University , Hamburg, Germany
| | - Sergio Machado
- Institute of Psychiatry, Federal University of Rio De Janeiro , Rio De Janeiro, Brazil.,International Neuroscience Research Group , Yucatan, México.,Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado De Oliveira University (UNIVERSO) , Niterói, Brazil.,Laboratory of Physical Activity Neuroscience, Neurodiversity Institute, Queimados , RJ, Brazil
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100
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Speyer H, Jakobsen AS, Westergaard C, Nørgaard HCB, Jørgensen KB, Pisinger C, Krogh J, Hjorthøj C, Nordentoft M, Gluud C, Correll CU. Lifestyle Interventions for Weight Management in People with Serious Mental Illness: A Systematic Review with Meta-Analysis, Trial Sequential Analysis, and Meta-Regression Analysis Exploring the Mediators and Moderators of Treatment Effects. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:350-362. [PMID: 31522170 DOI: 10.1159/000502293] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serious mental illness (SMI) reduces life expectancy, primarily due to somatic comorbidity linked to obesity. Meta-analyses have found beneficial effects of lifestyle interventions in people with SMI and recommended their implementation to manage obesity. OBJECTIVE The objective of this systematic review was to assess the benefits and harms of individualized lifestyle interventions for weight in people diagnosed with SMI and to explore potential mediators and moderators of the effect. METHODS The protocol was registered at PROSPERO (CRD42016049093). Randomized clinical trials (RCTs) assessing the effect of individualized lifestyle interventions on weight management in people with SMI were included. Primary outcomes were differences in endpoint body mass index (BMI) and the proportion achieving clinically relevant weight loss (≥5%). Secondary outcomes included quality of life, cardiometabolic risk factors, and adverse effects. RESULTS We included 41 RCTs (n = 4,267). All trials were at high risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. The experimental interventions reduced the mean difference in BMI by -0.63 kg/m2 (95% confidence interval [CI] = -1.02 to -0.23; p = 0.002; I2 = 70.7%) compared to the control groups. At postintervention follow-up (17 RCTs), the effect size remained similar but was no longer significant (BMI = -0.63 kg/m2; 95% CI = -1.30 to 0.04; p = 0.07; I2 = 48.8%). The risk ratio for losing ≥5% of baseline weight was 1.51 (95% CI = 1.07-2.13; p = 0.02) compared to the control groups. GRADE showed very low or low quality of evidence. CONCLUSION There is a statistically significant, but clinically insignificant, mean effect of individualized lifestyle interventions for weight reduction in people with SMI.
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Affiliation(s)
- Helene Speyer
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark,
| | - Ane Storch Jakobsen
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Casper Westergaard
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | | | | | - Charlotta Pisinger
- Research Center for Prevention and Health, Department 84-85, Glostrup University Hospital, Glostrup, Denmark
| | - Jesper Krogh
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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