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Yarborough BJH, Leo MC, Yarborough MT, Stumbo S, Janoff SL, Perrin NA, Green CA. Improvement in Body Image, Perceived Health, and Health-Related Self-Efficacy Among People With Serious Mental Illness: The STRIDE Study. Psychiatr Serv 2016; 67:296-301. [PMID: 26522674 PMCID: PMC7104613 DOI: 10.1176/appi.ps.201400535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined secondary outcomes of STRIDE, a randomized controlled trial that tested a weight-loss and lifestyle intervention for individuals taking antipsychotic medications. METHODS Hierarchical linear regression was used to explore the effects of the intervention and weight change at follow-up (six, 12, and 24 months) on body image, perceived health, and health-related self-efficacy. RESULTS Participants were 200 adults who were overweight and taking antipsychotic agents. Weight change × study arm interaction was associated with significant improvement in body image from baseline to six months. From baseline to 12 months, body image scores of intervention participants improved by 1.7 points more compared with scores of control participants; greater weight loss was associated with more improvement. Between baseline and 24 months, greater weight loss was associated with improvements in body image, perceived health, and health-related self-efficacy. CONCLUSIONS Participation in STRIDE improved body image, and losing weight improved perceived health and health-related self-efficacy.
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Affiliation(s)
- Bobbi Jo H Yarborough
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Michael C Leo
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Micah T Yarborough
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Scott Stumbo
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Shannon L Janoff
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Nancy A Perrin
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
| | - Carla A Green
- The authors are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (e-mail: )
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102
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Yarborough BJH, Stumbo SP, Yarborough MT, Young TJ, Green CA. Improving lifestyle interventions for people with serious mental illnesses: Qualitative results from the STRIDE study. Psychiatr Rehabil J 2016; 39:33-41. [PMID: 26214184 PMCID: PMC4729655 DOI: 10.1037/prj0000151] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Individuals with serious mental illnesses are disproportionately affected by overweight and obesity. Understanding the factors that facilitate or hinder lifestyle change in this population could lead to better interventions and improved health outcomes. METHODS A subset of intervention and usual-care participants (n = 84) in the STRIDE randomized trial were interviewed at 3, 9, and 18 months, yielding 101 interviews (some were interviewed more than once). Participants had a mean age of 48.1 (SD = 10.1); 64% were female. Participants had diagnoses of schizophrenia or schizoaffective disorder (41%), bipolar disorder (20%), affective psychoses (37%), or PTSD (2%). Interviews were transcribed verbatim, coded using Atlas.ti, and analyzed for common themes. RESULTS Barriers to behavior change were similar to those described for the general population, including lack of support from significant others, the lure of unhealthy foods, and poor weather impeding exercise. Additional challenges included the effects of psychiatric symptoms, or consequences of symptoms (i.e., social isolation), on ability to make and sustain lifestyle changes. We found a strong preference for ongoing, group-based support to foster a sense of accountability which motivated and helped to sustain behavior changes. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Individuals with serious mental illnesses encounter many of the same barriers to weight loss seen in the general population, but they may be more vulnerable to additional obstacles. Lifestyle change interventions for this population should help participants develop the ability to iteratively cope with fluctuating mood and subsequent changes in motivation to eat healthfully and exercise regularly.
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Affiliation(s)
| | | | | | | | - Carla A Green
- Kaiser Permanente Northwest, Center for Health Research
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103
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Firth J, Carney R, Jerome L, Elliott R, French P, Yung AR. The effects and determinants of exercise participation in first-episode psychosis: a qualitative study. BMC Psychiatry 2016; 16:36. [PMID: 26896958 PMCID: PMC4761413 DOI: 10.1186/s12888-016-0751-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous qualitative studies have found that exercise may facilitate symptomatic and functional recovery in people with long-term schizophrenia. This study examined the perceived effects of exercise as experienced by people in the early stages of psychosis, and explored which aspects of an exercise intervention facilitated or hindered their engagement. METHODS Nineteen semi-structured interviews were conducted with early intervention service users who had participated in a 10-week exercise intervention. Interviews discussed people's incentives and barriers to exercise, short- and long-term effects, and opinions on optimal interventions. A thematic analysis was applied to determine the prevailing themes. RESULTS The intervention was perceived as beneficial and engaging for participants. The main themes were (a) exercise alleviating psychiatric symptoms, (b) improved self-perceptions following exercise, and (c) factors determining exercise participation, with three respective sub-themes for each. CONCLUSIONS Participants explained how exercise had improved their mental health, improved their confidence and given them a sense of achievement. Autonomy and social support were identified as critical factors for effectively engaging people with first-episode psychosis in moderate-to-vigorous exercise. Implementing such programs in early intervention services may lead to better physical health, symptom management and social functioning among service users. TRIAL REGISTRATION Current Controlled Trials ISRCTN09150095. Registered 10 December 2013.
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Affiliation(s)
- Joseph Firth
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 3.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Rebekah Carney
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 3.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Lauren Jerome
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 3.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Rebecca Elliott
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 3.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK ,Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK ,Department of Psychological Sciences, The University of Liverpool, Liverpool, UK
| | - Alison R. Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 3.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK ,Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
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104
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Yarborough BJ. Health promotion coaching for obese individuals with serious mental illnesses produces clinically significant reductions in cardiovascular risks up to 18 months. EVIDENCE-BASED MENTAL HEALTH 2016; 19:31. [PMID: 26747874 PMCID: PMC10699346 DOI: 10.1136/eb-2015-102141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/19/2015] [Accepted: 11/26/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Bobbi Jo Yarborough
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA;
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105
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Naslund JA, Aschbrenner KA, Scherer EA, Pratt SI, Wolfe RS, Bartels SJ. Lifestyle Intervention for People With Severe Obesity and Serious Mental Illness. Am J Prev Med 2016; 50:145-53. [PMID: 26385164 PMCID: PMC4718763 DOI: 10.1016/j.amepre.2015.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/30/2015] [Accepted: 07/17/2015] [Indexed: 02/05/2023]
Abstract
INTRODUCTION People with serious mental illness experience elevated severe obesity rates, yet limited evidence documents whether lifestyle intervention participation can benefit these individuals. This study examined the impact of the In SHAPE lifestyle intervention on weight loss among participants with serious mental illness and severe obesity (BMI ≥40) compared with participants who are overweight (BMI 25 to <30) and have class I (BMI 30 to <35) or class II (BMI 35 to <40) obesity. METHODS Data were combined from three trials of the 12-month In SHAPE intervention for individuals with serious mental illness collected between 2007 and 2013 and analyzed in 2014. In SHAPE includes individual weekly meetings with a fitness trainer, a gym membership, and nutrition education. The primary outcome was weight loss. Secondary outcomes were fitness, blood pressure, lipids, and program adherence. RESULTS Participants (N=192) were diagnosed with schizophrenia spectrum (53.1%) or mood (46.9%) disorders. At 12 months, the overall sample showed significant weight loss, but differences among BMI groups were not significant (severe obesity, 2.57% [7.98%]; class II, 2.26% [8.69%]; class I, 1.05% [6.86%]; overweight, 0.83% [7.62%]). One third of participants with severe obesity achieved ≥5% weight loss, which was comparable across groups. More participants with severe obesity achieved ≥10% weight loss (20%) than overweight (2.9%, p=0.001) and class I (5.9%, p<0.001), but not class II (17.8%, p=0.974), obesity groups. CONCLUSIONS People with severe obesity and serious mental illness benefit similarly to those in lower BMI groups from lifestyle intervention participation.
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Affiliation(s)
- John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.
| | - Kelly A Aschbrenner
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Emily A Scherer
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sarah I Pratt
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Rosemarie S Wolfe
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Stephen J Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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106
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McGinty EE, Baller J, Azrin ST, Juliano-Bult D, Daumit GL. Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review. Schizophr Bull 2016; 42. [PMID: 26221050 PMCID: PMC4681556 DOI: 10.1093/schbul/sbv101] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.
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Affiliation(s)
- Emma E. McGinty
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;,*To whom correspondence should be addressed; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, US; tel: 410-614-4018, e-mail:
| | - Julia Baller
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Gail L. Daumit
- Division of General Internal Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
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107
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Hutchison SL, Terhorst L, Murtaugh S, Gross S, Kogan JN, Shaffer SL. Effectiveness of a Staff Promoted Wellness Program to Improve Health in Residents of a Mental Health Long-Term Care Facility. Issues Ment Health Nurs 2016; 37:257-64. [PMID: 27031533 DOI: 10.3109/01612840.2015.1126774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The current study describes physical and mental health outcomes during a health promotion program for individuals with serious mental illness (SMI). A sample of 43 adults in a long-term residential facility volunteered for an individualized, healthy lifestyle program designed to promote physical activity and combat premature mortality among individuals with SMI. Nurses and residential counselors were trained in the program and encouraged to work collaboratively with the program's personal trainers. Weekly nutrition and activity logs were obtained over the year-long evaluation. Assessments of physical and psychological health indicators were collected quarterly. Qualitative data through focus groups described staff experience. Self-report of moderate and vigorous physical activity improved over time as did fitness level as measured through a walking challenge (p = .001). Significant decreases in weight (p < .001), BMI (p = .001), and total cholesterol (p < .001) were observed from baseline through 12 months. Mean recovery scores (RMQ) were significantly higher between baseline and all time points (p < .001). Participants reported decreasing levels of depression (PHQ-9) by the 12-month time point (p < .001). Staff encouraged participation in physical activity and observed improved motivation and socialization among participants. A health promotion program with participation encouraged by health care staff is effective for increasing physical activity and improving physical and mental health outcomes in individuals with SMI in long-term residential care.
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Affiliation(s)
- Shari L Hutchison
- a Community Care Behavioral Health , UPMC Insurance Services Division , Pittsburgh , Pennsylvania , USA
| | - Lauren Terhorst
- b University of Pittsburgh , School of Nursing , Pittsburgh , Pennsylvania , USA
| | | | - Sarah Gross
- d ActiveHealth Management , Rolling Meadows , Illinois , USA
| | - Jane N Kogan
- e UPMC Center for High Value Health Care , Pittsburgh , Pennsylvania , USA
| | - Sherry L Shaffer
- a Community Care Behavioral Health , UPMC Insurance Services Division , Pittsburgh , Pennsylvania , USA
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108
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Aschbrenner KA, Naslund JA, Gill LE, Bartels SJ, Ben-Zeev D. A Qualitative Study of Client-Clinician Text Exchanges in a Mobile Health Intervention for Individuals With Psychotic Disorders and Substance Use. J Dual Diagn 2016; 12:63-71. [PMID: 26829356 PMCID: PMC4837061 DOI: 10.1080/15504263.2016.1145312] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Mobile health (mHealth) approaches have the potential to transform prevention, wellness, and illness management for people with dual diagnosis consisting of co-occurring mental illness and substance use disorders by providing timely and cost-effective interventions in clients' natural environments. However, little is known about how clients interact with mHealth interventions to manage their illness. This qualitative study explored the content of mobile phone text messages between clients with dual diagnosis and a clinician who engaged them in daily assessment and intervention text exchanges. METHODS Seventeen participants with psychotic disorders and substance use were enrolled in a 12-week single-arm trial of an mHealth intervention focusing on illness management. The clinician (i.e., mobile interventionist) sent daily text messages to participants' privately owned mobile phones to assess their medication adherence and clinical status. The clinician provided other illness management and wellness suggestions flexibly, in response to participants' needs and preferences. In this qualitative study we conducted a thematic analysis of the client-clinician text exchanges that occurred over the course of the intervention. RESULTS Seven major content themes in client-clinician text message exchanges were identified: mental health symptoms; mental health coping strategies; mental health treatment and management; lifestyle behaviors; social relationships and leisure activities; motivation and personal goal setting; and independent living. Participants were interested in discussing strategies for coping with mental health symptoms (e.g., cognitive restructuring, social support) and health behavior change (e.g., increased physical activity, dietary changes). CONCLUSIONS Our findings suggest that client-centered text messaging has the potential to be an important component of illness management for people with dual diagnosis. This approach is able to offer coping strategies that are tailored to clients' needs and preferences in real time when help is needed.
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Affiliation(s)
- Kelly A. Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH
- mHealth for Mental Health Program, Dartmouth Psychiatric Research Center, Lebanon, NH
| | - John A. Naslund
- Health Promotion Research Center at Dartmouth, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH
| | - Lydia E. Gill
- Health Promotion Research Center at Dartmouth, Lebanon, NH
| | - Stephen J. Bartels
- Health Promotion Research Center at Dartmouth, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH
- mHealth for Mental Health Program, Dartmouth Psychiatric Research Center, Lebanon, NH
| | - Dror Ben-Zeev
- mHealth for Mental Health Program, Dartmouth Psychiatric Research Center, Lebanon, NH
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
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109
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Naslund JA, Aschbrenner KA, Pratt SI, Bartels SJ. Comparison of people with serious mental illness and general population samples enrolled in lifestyle interventions for weight loss. Schizophr Res 2015; 169:486-488. [PMID: 26427918 PMCID: PMC4826726 DOI: 10.1016/j.schres.2015.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 08/14/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- John A. Naslund
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States. The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
| | - Kelly A. Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States. The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States. Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sarah I. Pratt
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States. The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States. Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Stephen J. Bartels
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States. The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States. Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States. Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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110
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Macias C, Panch T, Hicks YM, Scolnick JS, Weene DL, Öngür D, Cohen BM. Using Smartphone Apps to Promote Psychiatric and Physical Well-Being. Psychiatr Q 2015; 86:505-19. [PMID: 25636496 DOI: 10.1007/s11126-015-9337-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This pilot study tested the acceptability and usability of a prototype app designed to promote the physical well-being of adults with psychiatric disorders. The application under evaluation, WellWave, promoted walking as a physical exercise, and offered a variety of supportive non-physical activities, including confidential text-messaging with peer staff, and a digital library of readings and videos on recovery from psychiatric illness. Study participants engaged strongly in the app throughout the 4-week study, showing a 94 % mean daily usage rate, and a 73 % mean response rate across all electronic messages and prompts, which approximates the gold standard of 75 % for momentary ecological assessment studies. Seven of the ten study participants averaged two or more walks per week, beginning with 5-min walks and ending with walks lasting 20 min or longer. This responsiveness to the walking prompts, and the overall high rate of engagement in other app features, suggest that adults with psychiatric conditions would welcome and benefit from similar smartphone interventions that promote healthy behaviours in life domains other than exercise. Pilot study results also suggest that smartphone applications can be useful as research tools in the development and testing of theories and practical strategies for encouraging healthy lifestyles. Participants were prompted periodically to rate their own health quality, perceived control over their health, and stage-of-change in adopting a walking routine, and these electronic self-ratings showed acceptable concurrent and discriminant validity, with all participants reporting moderate to high motivation to exercise by the end of the study.
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Affiliation(s)
- Cathaleene Macias
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,McLean Hospital, Belmont, MA, USA.
| | | | - Yale M Hicks
- Waverley Place at Waverley Square, McLean Hospital, Belmont, MA, USA.
| | - Jason S Scolnick
- Waverley Place at Waverley Square, McLean Hospital, Belmont, MA, USA.
| | - David Lyle Weene
- Waverley Place at Waverley Square, McLean Hospital, Belmont, MA, USA.
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA.
| | - Bruce M Cohen
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,Program for Neuropsychiatric Research, McLean Hospital, Belmont, MA, USA.
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111
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Green CA, Yarborough BJH, Leo MC, Stumbo SP, Perrin NA, Nichols GA, Stevens VJ. Weight maintenance following the STRIDE lifestyle intervention for individuals taking antipsychotic medications. Obesity (Silver Spring) 2015; 23:1995-2001. [PMID: 26334929 PMCID: PMC4586363 DOI: 10.1002/oby.21205] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/09/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Individuals taking antipsychotic medications have increased risk of obesity-related early morbidity/mortality. This report presents weight maintenance results from a successful weight loss and behavioral lifestyle change program developed for people taking antipsychotic medications. METHODS STRIDE was a two-arm randomized controlled trial. Intervention participants attended weekly group meetings for 6 months, then monthly group meetings for 6 months. Assessments were completed at baseline and at 6, 12, and 24 months. RESULTS At 24 months, intervention participants lost 3.7% of baseline weight and control participants 2.1%, a non-significant difference. Fasting glucose results followed a similar pattern. There was a statistically significant difference, however, for fasting insulin-the intervention group's levels decreased between the end of the intensive intervention (at 6 months) and 24 months (10.1-7.91 μU/mL); control participants' levels increased (11.66 to 12.92 μU/mL) during this period. There were also fewer medical hospitalizations among intervention participants (5.7%) than controls (21.1%; χ(2) = 8.47, P = 0.004) during the 12- to 24-month post-intervention maintenance period. CONCLUSIONS Weight change differences between arms diminished following the intervention period, though fasting insulin levels continued to improve. Reduced hospitalizations suggest that weight loss, even with regain, may have long-term positive benefits for people taking antipsychotic medications and may reduce costs.
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Affiliation(s)
- Carla A Green
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Scott P Stumbo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Nancy A Perrin
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Gregory A Nichols
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Victor J Stevens
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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112
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Cabassa LJ, Stefancic A, O'Hara K, El-Bassel N, Lewis-Fernández R, Luchsinger JA, Gates L, Younge R, Wall M, Weinstein L, Palinkas LA. Peer-led healthy lifestyle program in supportive housing: study protocol for a randomized controlled trial. Trials 2015; 16:388. [PMID: 26329472 PMCID: PMC4557630 DOI: 10.1186/s13063-015-0902-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/05/2015] [Indexed: 01/28/2023] Open
Abstract
Background The risk for obesity is twice as high in people with serious mental illness (SMI) compared to the general population. Racial and ethnic minority status contribute additional health risks. The aim of this study is to describe the protocol of a Hybrid Trial Type 1 design that will test the effectiveness and examine the implementation of a peer-led healthy lifestyle intervention in supportive housing agencies serving diverse clients with serious mental illness who are overweight or obese. Methods The Hybrid Trial Type 1 design will combine a randomized effectiveness trial with a mixed-methods implementation study. The effectiveness trial will test the health impacts of a peer-led healthy lifestyle intervention versus usual care in supportive housing agencies. The healthy lifestyle intervention is derived from the Group Lifestyle Balanced Program, lasts 12 months, and will be delivered by trained peer specialists. Repeated assessments will be conducted at baseline and at 6, 12, and 18 months post randomization. A mixed-methods (e.g., structured interviews, focus groups, surveys) implementation study will be conducted to examine multi-level implementation factors and processes that can inform the use of the healthy lifestyle intervention in routine practice, using data from agency directors, program managers, staff, and peer specialists before, during, and after the implementation of the effectiveness trial. Discussion This paper describes the use of a hybrid research design that blends effectiveness trial methodologies and implementation science rarely used when studying the physical health of people with SMI and can serve as a model for integrating implementation science and health disparities research. Rigorously testing effectiveness and exploring the implementation process are both necessary steps to establish the evidence for large-scale delivery of peer-led healthy lifestyle intervention to improve the physical health of racial/ethnic minorities with SMI. Trial registration www.clinicaltrials.gov; NCT02175641, registered 24 June 2014
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Affiliation(s)
- Leopoldo J Cabassa
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Ana Stefancic
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Kathleen O'Hara
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Nabila El-Bassel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | | | - José A Luchsinger
- Columbia University Medical Center, Presbyterian Hospital, 622 West 168th St, New York, NY, 10032, USA.
| | - Lauren Gates
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Richard Younge
- New York Presbyterian, Family Medicine, 610 West 158th St, New York, NY, 10032, USA.
| | - Melanie Wall
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Lara Weinstein
- Jefferson University Hospital, 833 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Lawrence A Palinkas
- University of Southern California School of Social Work, University Park, Los Angeles, CA, 90089, USA.
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Aschbrenner KA, Naslund JA, Barre LK, Mueser KT, Kinney A, Bartels SJ. Peer health coaching for overweight and obese individuals with serious mental illness: intervention development and initial feasibility study. Transl Behav Med 2015; 5:277-84. [PMID: 26327933 PMCID: PMC4537456 DOI: 10.1007/s13142-015-0313-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Effective and scalable interventions are needed to reach a greater proportion of individuals with serious mental illness (SMI) who experience alarmingly high rates of obesity. This pilot study evaluated the feasibility of translating an evidenced-based professional health coach model (In SHAPE) to peer health coaching for overweight and obese individuals with SMI. Key stakeholders collaborated to modify In SHAPE to include a transition from professional health coaching to individual and group-based peer health coaching enhanced by mobile health technology. Ten individuals with SMI were recruited from a public mental health agency to participate in a 6-month feasibility pilot study of the new model. There was no overall significant change in mean weight; however, over half (56 %) of participants lost weight by the end of the intervention with mean weight loss 2.7 ± 2.1 kg. Participants reported high satisfaction and perceived benefits from the program. Qualitative interviews with key stakeholders indicated that the intervention was implemented as planned. This formative research showed that peer health coaching for individuals with SMI is feasible. Further research is needed to evaluate its effectiveness.
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Affiliation(s)
- Kelly A. Aschbrenner
- />Dartmouth Centers for Health and Aging, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
- />Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, NH USA
- />The Dartmouth Instiute for Health Policy and Clinical Practice, Lebanon, NH USA
| | - John A. Naslund
- />Dartmouth Centers for Health and Aging, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
- />Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, NH USA
- />The Dartmouth Instiute for Health Policy and Clinical Practice, Lebanon, NH USA
| | - Laura K. Barre
- />Division of Nutritional Sciences, Cornell University, Ithaca, NY USA
| | - Kim T. Mueser
- />Center for Psychiatric Rehabilitation, Boston University, Boston, MA USA
| | - Allison Kinney
- />Dartmouth Centers for Health and Aging, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
| | - Stephen J. Bartels
- />Dartmouth Centers for Health and Aging, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
- />Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, NH USA
- />The Dartmouth Instiute for Health Policy and Clinical Practice, Lebanon, NH USA
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The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities. Harv Rev Psychiatry 2015; 23:304-19. [PMID: 25811340 PMCID: PMC4894763 DOI: 10.1097/hrp.0000000000000086] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA.
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115
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Stanton R, Reaburn P, Happell B. Barriers to exercise prescription and participation in people with mental illness: the perspectives of nurses working in mental health. J Psychiatr Ment Health Nurs 2015; 22:440-8. [PMID: 25855247 DOI: 10.1111/jpm.12205] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 12/11/2022]
Abstract
ACCESSIBLE SUMMARY Exercise is valuable in the treatment of mental illness, yet personal and organizational barriers limit widespread implementation by nurses in mental health settings. Using a self-report questionnaire, we sought to identify how often nurses prescribe exercise and their level of agreement with previously identified barriers to exercise prescription and participation for mental health consumers. Nurses disagree that many of the previously identified barriers should impede exercise prescription for people with mental illness. Nurses agree that many of the barriers expressed by mental health consumers might prevent exercise participation. Our study provides valuable new insight into the role of nurses in the provision of exercise for people with mental illness; however, it is limited to a small sample. Confirmation of these findings in larger, geographically and professionally diverse groups is needed. ABSTRACT Evidence is mounting for the efficacy of exercise in the treatment of people with mental illness. Nurses working in mental health settings are well placed to provide exercise advice for people with mental illness. However, quantitative examinations of the barriers to exercise prescription experienced by nurses, or their views regarding the barriers to exercise participation experienced by people with mental illness, are lacking. In this study, 34 nurses completed the Exercise in Mental Illness Questionnaire-Health Professionals Version (EMIQ-HP). This survey examined the frequency of exercise prescription and the level of agreement with statements regarding barriers to exercise prescription for, and exercise participation by, people with mental illness. The level of agreement scores for statements for each section was summed, with a higher score indicating a higher level of agreement. Nurses disagree with many of the barriers to exercise prescription presented in the literature. The level of agreement scores did not differ between nurses who prescribe exercise 'Always', 'Most of the time', 'Occasionally' or 'Never'. We found a non-significant negative relationship between frequency of exercise prescription and summed level of agreement scores for barriers to exercise prescription. Consensus regarding barriers to exercise participation by mental health consumers is less clear. This study provides valuable new insight into the role of nurses in the provision of exercise for people with mental illness. Confirmation in larger samples is needed before translation of research to practice.
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Affiliation(s)
- R Stanton
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - P Reaburn
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - B Happell
- Research Centre for Nursing and Midwifery Practice, University of Canberra, Canberra, ACT, Australia.,Research Centre for Nursing and Midwifery Practice, ACT Health, Canberra, ACT, Australia
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Gates J, Killackey E, Phillips L, Álvarez-Jiménez M. Mental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis. Lancet Psychiatry 2015; 2:726-742. [PMID: 26249304 DOI: 10.1016/s2215-0366(15)00213-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/30/2015] [Accepted: 04/23/2015] [Indexed: 12/18/2022]
Abstract
People with psychotic disorders have reduced life expectancy compared with the general population. This difference is primarily due to increased prevalence of cardiovascular disease associated with antipsychotic drugs and with modifiable risk factors, including weight gain, low exercise, poor diet, and high prevalence of cigarette smoking. We review non-pharmacological interventions for physical health behaviour in patients with chronic and first-episode psychosis. Our findings suggest that weight loss and attenuation of weight gain are achievable but limited and might not persist beyond the end of an intervention. Evidence for smoking cessation interventions is scarce. The case for early intervention to prevent deterioration of physical health is strong. We propose a framework for development of interventions, which addresses three main factors largely absent in previous research: (1) examination of aetiological factors related to poor physical health, (2) theory-driven interventions that target aetiological factors, and (3) assessment of feasibility.
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Affiliation(s)
- Jesse Gates
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Lisa Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Mario Álvarez-Jiménez
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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117
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Cigarette smoking and interest in quitting among overweight and obese adults with serious mental illness enrolled in a fitness intervention. J Nerv Ment Dis 2015; 203:473-6. [PMID: 26034872 PMCID: PMC4851338 DOI: 10.1097/nmd.0000000000000309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study explored cigarette smoking, health status, and interest in quitting among overweight and obese adults with serious mental illness enrolled in a fitness intervention. Baseline data from two studies of the In SHAPE fitness intervention were combined. A total of 341 overweight or obese adults with serious mental illness were assessed on smoking, interest in quitting, cardiovascular fitness, lipids, body mass index, readiness to change diet, and psychiatric symptoms. Thirty-six percent (n = 122) of participants were categorized as current smokers. The majority of smokers (84%) were interested in quitting. Smokers were more likely to be younger, male, and less educated than non-smokers. Smokers had lower high-density lipoprotein cholesterol and were less ready to reduce dietary fat, after adjusting for age, gender, and education. Findings highlight the potential to address both fitness and smoking to reduce cardiovascular risk in individuals with serious mental illness.
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118
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Aschbrenner K, Mueser K, Bartels S, Carpenter-Song E, Pratt S, Barre L, Naslund J, Kinney A. The other 23 hours: a qualitative study of fitness provider perspectives on social support for health promotion for adults with mental illness. HEALTH & SOCIAL WORK 2015; 40:91-9. [PMID: 26027417 PMCID: PMC4462649 DOI: 10.1093/hsw/hlv006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/09/2013] [Accepted: 12/18/2013] [Indexed: 05/26/2023]
Abstract
Current efforts to reduce the increased risk of premature death from preventable cardiovascular disease among adults with serious mental illness (SMI) through lifestyle change have had limited success. Engaging informal support systems to promote healthy behaviors in everyday life may increase the effectiveness of health promotion interventions targeting this at-risk population. In-depth semistructured interviews were conducted with 10 fitness trainers serving adults with SMI in a health promotion program at community mental health centers to explore their perspectives on the potential of enlisting support from significant others for health behavior change. Trainers reported that the majority of participants had a relative or significant other who influenced their health behaviors, and they saw potential value in involving them in efforts to improve health outcomes by extending support into participants' daily lives. They did not feel qualified to work with families of individuals with mental illness, but they were willing to partner with providers who had experience in this area. Social workers who practice with families could play a critical role on health promotion teams addressing cardiovascular risk in adults with SMI by using their skills and experiences to engage families in supporting a relative through the process of health behavior change.
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119
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Bartels SJ, Pratt SI, Aschbrenner KA, Barre LK, Naslund JA, Wolfe R, Xie H, McHugo GJ, Jimenez DE, Jue K, Feldman J, Bird BL. Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes. Am J Psychiatry 2015; 172:344-52. [PMID: 25827032 PMCID: PMC4537796 DOI: 10.1176/appi.ajp.2014.14030357] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Few studies targeting obesity in serious mental illness have reported clinically significant risk reduction, and none have been replicated in community settings or demonstrated sustained outcomes after intervention withdrawal. The authors sought to replicate positive health outcomes demonstrated in a previous randomized effectiveness study of the In SHAPE program across urban community mental health organizations serving an ethnically diverse population. METHOD Persons with serious mental illness and a body mass index (BMI) >25 receiving services in three community mental health organizations were recruited and randomly assigned either to the 12-month In SHAPE program, which included membership in a public fitness club and weekly meetings with a health promotion coach, or to fitness club membership alone. The primary outcome measures were weight and cardiorespiratory fitness (as measured with the 6-minute walk test), assessed at baseline and at 3, 6, 9, 12, and 18 months. RESULTS Participants (N=210) were ethnically diverse (46% were nonwhite), with a mean baseline BMI of 36.8 (SD=8.2). At 12 months, the In SHAPE group (N=104) had greater reduction in weight and improved fitness compared with the fitness club membership only group (N=106). Primary outcomes were maintained at 18 months. Approximately half of the In SHAPE group (51% at 12 months and 46% at 18 months) achieved clinically significant cardiovascular risk reduction (a weight loss ≥5% or an increase of >50 meters on the 6-minute walk test). CONCLUSIONS This is the first replication study confirming the effectiveness of a health coaching intervention in achieving and sustaining clinically significant reductions in cardiovascular risk for overweight and obese persons with serious mental illness.
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120
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Lesley ML, Livingwood K. Assessing Sustainability of InSHAPE Participants’ Fitness Activities in a Community Mental Health Setting. J Psychosoc Nurs Ment Health Serv 2015; 53:46-53. [DOI: 10.3928/02793695-20150126-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/19/2015] [Indexed: 11/20/2022]
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121
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Littman AJ, Damschroder LJ, Verchinina L, Lai Z, Kim HM, Hoerster KD, Klingaman EA, Goldberg RW, Owen RR, Goodrich DE. National evaluation of obesity screening and treatment among veterans with and without mental health disorders. Gen Hosp Psychiatry 2015; 37:7-13. [PMID: 25500194 DOI: 10.1016/j.genhosppsych.2014.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to determine whether obesity screening and weight management program participation and outcomes are equitable for individuals with serious mental illness (SMI) and depressive disorder (DD) compared to those without SMI/DD in Veterans Health Administration (VHA), the largest integrated US health system, which requires obesity screening and offers weight management to all in need. METHODS We used chart-reviewed, clinical and administrative VHA data from fiscal years 2010-2012 to estimate obesity screening and participation in the VHA's weight management program (MOVE!) across groups. Six- and 12-month weight changes in MOVE! participants were estimated using linear mixed models adjusted for confounders. RESULTS Compared to individuals without SMI/DD, individuals with SMI or DD were less frequently screened for obesity (94%-94.7% vs. 95.7%) but had greater participation in MOVE! (10.1%-10.4% vs. 7.4%). MOVE! participants with SMI or DD lost approximately 1 lb less at 6 months. At 12 months, average weight loss for individuals with SMI or neither SMI/DD was comparable (-3.5 and -3.3 lb, respectively), but individuals with DD lost less weight (mean=-2.7 lb). CONCLUSIONS Disparities in obesity screening and treatment outcomes across mental health diagnosis groups were modest. However, participation in MOVE! was low for every group, which limits population impact.
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Affiliation(s)
- Alyson J Littman
- VA Puget Sound Healthcare System, Seattle Division Epidemiologic Research and Information Center (ERIC), Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Laura J Damschroder
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA.
| | - Lilia Verchinina
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA.
| | - Zongshan Lai
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
| | - Hyungjin Myra Kim
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA; Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, MI.
| | - Katherine D Hoerster
- VA Puget Sound Healthcare System, Seattle Division Mental Health Service; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Elizabeth A Klingaman
- VA Capitol Health Care Network Mental Illness Research, Education, and Clinical Center, Baltimore, MD; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD.
| | - Richard W Goldberg
- VA Capitol Health Care Network Mental Illness Research, Education, and Clinical Center, Baltimore, MD.
| | - Richard R Owen
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR; Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR.
| | - David E Goodrich
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
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Leutwyler H, Hubbard E, Cooper B, Dowling G. The Impact of a Videogame-Based Pilot Physical Activity Program in Older Adults with Schizophrenia on Subjectively and Objectively Measured Physical Activity. Front Psychiatry 2015; 6:180. [PMID: 26733891 PMCID: PMC4685058 DOI: 10.3389/fpsyt.2015.00180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/07/2015] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES The purpose of this report is to describe the impact of a videogame-based pilot physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA, USA) on physical activity in older adults with schizophrenia. METHODS In this one group pre-test, post-test pilot study, 20 participants played an active videogame for 30 min, once a week for 6 weeks. Physical activity was measured by self-report with the Yale Physical Activity Survey and objectively with the Sensewear Pro armband at enrollment and at the end of the 6-week program. RESULTS There was a significant increase in frequency of self-reported vigorous physical activity. We did not detect a statistically significant difference in objectively measured physical activity although increase in number of steps and sedentary activity were in the desired direction. CONCLUSION These results suggest participants' perception of physical activity intensity differs from the intensity objectively captured with a valid and reliable physical activity monitor.
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Affiliation(s)
- Heather Leutwyler
- Physiological Nursing, University of California San Francisco , San Francisco, CA , USA
| | - Erin Hubbard
- Physiological Nursing, University of California San Francisco , San Francisco, CA , USA
| | - Bruce Cooper
- School of Nursing, University of California San Francisco , San Francisco, CA , USA
| | - Glenna Dowling
- Physiological Nursing, University of California San Francisco , San Francisco, CA , USA
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123
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Green CA, Yarborough BJH, Leo MC, Yarborough MT, Stumbo SP, Janoff SL, Perrin NA, Nichols GA, Stevens VJ. The STRIDE weight loss and lifestyle intervention for individuals taking antipsychotic medications: a randomized trial. Am J Psychiatry 2015; 172:71-81. [PMID: 25219423 PMCID: PMC4282602 DOI: 10.1176/appi.ajp.2014.14020173] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The STRIDE study assessed whether a lifestyle intervention, tailored for individuals with serious mental illnesses, reduced weight and diabetes risk. The authors hypothesized that the STRIDE intervention would be more effective than usual care in reducing weight and improving glucose metabolism. METHOD The study design was a multisite, parallel two-arm randomized controlled trial in community settings and an integrated health plan. Participants who met inclusion criteria were ≥18 years old, were taking antipsychotic agents for ≥30 days, and had a body mass index ≥27. Exclusions were significant cognitive impairment, pregnancy/breastfeeding, recent psychiatric hospitalization, bariatric surgery, cancer, heart attack, or stroke. The intervention emphasized moderate caloric reduction, the DASH (Dietary Approaches to Stop Hypertension) diet, and physical activity. Blinded staff collected data at baseline, 6 months, and 12 months. RESULTS Participants (men, N=56; women, N=144; mean age=47.2 years [SD=10.6]) were randomly assigned to usual care (N=96) or a 6-month weekly group intervention plus six monthly maintenance sessions (N=104). A total of 181 participants (90.5%) completed 6-month assessments, and 170 (85%) completed 12-month assessments, without differential attrition. Participants attended 14.5 of 24 sessions over 6 months. Intent-to-treat analyses revealed that intervention participants lost 4.4 kg more than control participants from baseline to 6 months (95% CI=-6.96 kg to -1.78 kg) and 2.6 kg more than control participants from baseline to 12 months (95% CI=-5.14 kg to -0.07 kg). At 12 months, fasting glucose levels in the control group had increased from 106.0 mg/dL to 109.5 mg/dL and decreased in the intervention group from 106.3 mg/dL to 100.4 mg/dL. No serious adverse events were study-related; medical hospitalizations were reduced in the intervention group (6.7%) compared with the control group (18.8%). CONCLUSIONS Individuals taking antipsychotic medications can lose weight and improve fasting glucose levels. Increasing reach of the intervention is an important future step.
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Naslund JA, Aschbrenner KA, Barre LK, Bartels SJ. Feasibility of popular m-health technologies for activity tracking among individuals with serious mental illness. Telemed J E Health 2014; 21:213-6. [PMID: 25536190 DOI: 10.1089/tmj.2014.0105] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Obesity prevalence is nearly double among individuals with serious mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder, or major depressive disorder, compared with the general population. Emerging mobile health (m-health) technologies are increasingly available and offer the potential to support lifestyle interventions targeting weight loss, yet the practical feasibility of using these technologies in this high-risk group has not been established. We evaluated the feasibility and acceptability of popular m-health technologies for activity tracking among overweight and obese individuals with SMI. We provided wearable activity monitoring devices (FitBit [San Francisco, CA] Zip™ or Nike Inc. [Beaverton, OR] FuelBand) and smartphones (Apple [Cupertino, CA] iPhone(®) 4S) for accessing the smartphone application for each device to participants with SMI enrolled in a weight loss program. Feasibility of these devices was measured by the frequency of use over time. Acceptability was measured through qualitative follow-up interviews with participants. Ten participants with SMI wore the devices for a mean of 89% (standard deviation=13%) of the days in the study. Five participants wore the devices 100% of the time. Participants reported high satisfaction, stating the devices were easy to use, helpful for setting goals, motivational, and useful for self-monitoring. Several participants liked the social connectivity feature of the devices where they could see each other's progress on the smartphone application, noting that "friendly" competition increased motivation to be more physically active. This study supports using popular m-health technologies for activity tracking among individuals with SMI. These findings can inform the design of weight loss interventions targeting this vulnerable patient population.
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Affiliation(s)
- John A Naslund
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Dartmouth College, Lebanon , New Hampshire
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125
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A 12-week weight reduction intervention for overweight individuals taking antipsychotic medications. Community Ment Health J 2014; 50:974-80. [PMID: 24566560 DOI: 10.1007/s10597-014-9716-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Abstract
People taking antipsychotic medications are at increased risk for obesity, diabetes, and early mortality. Few weight loss interventions have targeted this population. Thirty-six individuals were randomized to an evidence-based 12-week weight loss intervention (PREMIER with DASH diet, n = 18) or to usual care (n = 18) in this feasibility trial. Average attendance was 8.6 of 12 sessions. Intent-to-treat analyses of covariance, adjusted for baseline weight, showed significant changes in weight: Mean weight in intervention participants declined from 213.3 to 206.6 pounds, while control participants' weight was unchanged. It is possible to recruit, assess, intervene with, and retain participants taking antipsychotic medications in a dietary and exercise lifestyle change trial. Participants reported high levels of satisfaction with the intervention.
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126
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Abstract
This review provides clinicians and individuals with bipolar disorder (BD) with an overview of evidence-based skills shown to be effective in BD and amenable to self-management including psychoeducation; monitoring moods, medications, and social function; sleep hygiene; setting goals and relapse plans; and healthy lifestyles (physical activity, healthy eating, weight loss and management, medical comorbidities). Currently available self-management resources for BD are summarized by mode of delivery (workbooks, mobile technologies, internet, and peer-led interventions). Regardless of the self-management intervention/topic, the research suggests that personally tailored interventions of longer duration and greater frequency may be necessary to achieve the maximal benefit among individuals with BD. Means to support these self-management interventions as self-sustaining identities are critically needed. Hopefully, the recent investment in patient-centered research and care will result in best practices for the self-management of BD by mode of delivery. Since self-management of BD should complement rather than replace medical care, clinicians need to partner with their patients to incorporate and support advances in self-management for individuals with BD.
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127
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Viron M, Zioto K, Schweitzer J, Levine G. Behavioral Health Homes: an opportunity to address healthcare inequities in people with serious mental illness. Asian J Psychiatr 2014; 10:10-6. [PMID: 25042945 DOI: 10.1016/j.ajp.2014.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/14/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
People with serious mental illness (SMI) face striking reductions in lifespan versus the general population, in part due to the inadequacy of healthcare systems in meeting the substantial physical health needs of this group. Integrated care, the strategic combination and coordination of behavioral health and primary care services, has been proposed as a potential healthcare service delivery solution to address these care gaps. Inspired by the primary care Patient-Centered Medical Home concept, Behavioral Health Homes bring primary care services into the community mental health center in various ways. In this paper the authors review the literature describing Behavioral Health Home interventions and highlight an integration project that provides co-located and coordinated primary care and wellness services in a community mental health center. Such approaches hold great promise for improving the health and healthcare of people with SMI.
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Affiliation(s)
- Mark Viron
- Massachusetts Mental Health Center, Boston, MA, USA; Beth Israel Deaconess Medical Center, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Kathryn Zioto
- Harvard Medical School, Boston, MA, USA; Harvard Longwood Psychiatry Residency Training Program, Boston, MA, USA
| | - Jason Schweitzer
- Harvard Medical School, Boston, MA, USA; Harvard Longwood Psychiatry Residency Training Program, Boston, MA, USA
| | - Gail Levine
- Massachusetts Mental Health Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
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Kilbourne AM, Bramlet M, Barbaresso MM, Nord KM, Goodrich DE, Lai Z, Post EP, Almirall D, Verchinina L, Duffy SA, Bauer MS. SMI life goals: description of a randomized trial of a collaborative care model to improve outcomes for persons with serious mental illness. Contemp Clin Trials 2014; 39:74-85. [PMID: 25083802 DOI: 10.1016/j.cct.2014.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/19/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Persons with serious mental illnesses (SMI) are more likely to die earlier than the general population, primarily due to increased medical burden, particularly from cardiovascular disease (CVD). Life Goals Collaborative Care (LG-CC) is designed to improve health outcomes in SMI through self-management, care management, and provider support. This single-blind randomized controlled effectiveness study will determine whether patients with SMI receiving LG-CC compared to usual care (UC) experience improved physical health in 12 months. METHODS Patients diagnosed with SMI and at least one CVD risk factor receiving care at a VA mental health clinic were randomized to LG-CC or UC. LG-CC included five self-management sessions covering mental health symptom management reinforced through health behavior change, care coordination and health monitoring via a registry, and provider feedback. The primary outcome is change in physical health-related quality of life score (VR-12) from baseline to 12 months. Secondary outcomes include changes in mental health-related quality of life, CVD risk factors (blood pressure, BMI), and physical activity from baseline to 12 months later. RESULTS Out of 304 enrolled, 139 were randomized to LG-CC and 145 to UC. Among patients completing baseline assessments (N = 284); the mean age was 55.2 (SD = 10.9; range 28-75 years), 15.6% were women, the majority (62%) were diagnosed with depression, and the majority (63%) were diagnosed with hypertension or were overweight (BMI mean ± SD = 33.3 ± 6.3). Baseline VR-12 physical health component score was below population norms (50.0 ± SD = 10) at 33.4 ± 11.0. CONCLUSIONS Findings from this trial may inform initiatives to improve physical health for SMI patient populations.
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Affiliation(s)
- Amy M Kilbourne
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA.
| | - Margretta Bramlet
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA.
| | - Michelle M Barbaresso
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA.
| | - Kristina M Nord
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA.
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA.
| | - Zongshan Lai
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA.
| | - Edward P Post
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104-2321, USA.
| | - Lilia Verchinina
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA.
| | - Sonia A Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; University of Michigan School of Nursing, Division of Health Promotion and Risk Reduction, 400 N Ingalls Bldg, Rm 3178, Ann Arbor, MI 48109-5482, USA.
| | - Mark S Bauer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System 152M, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA.
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Leutwyler H, Hubbard EM, Dowling GA. Adherence to a Videogame-Based Physical Activity Program for Older Adults with Schizophrenia. Games Health J 2014; 3:227-33. [PMID: 26192371 DOI: 10.1089/g4h.2014.0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Adults with schizophrenia are a growing segment of the older adult population. Evidence suggests that they engage in limited physical activity. Interventions are needed that are tailored around their unique limitations. An active videogame-based physical activity program that can be offered at a treatment facility can overcome these barriers and increase motivation to engage in physical activity. The purpose of this report is to describe the adherence to a videogame-based physical activity program using the Kinect(®) for Xbox(®) 360 game system (Microsoft(®), Redmond, WA) in older adults with schizophrenia. MATERIALS AND METHODS This was a descriptive longitudinal study among 34 older adults with schizophrenia to establish the adherence to an active videogame-based physical activity program. In our ongoing program, once a week for 6 weeks, participants played an active videogame, using the Kinect for Xbox 360 game system, for 30 minutes. Adherence was measured with a count of sessions attended and with the total minutes attended out of the possible total minutes of attendance (180 minutes). RESULTS Thirty-four adults with schizophrenia enrolled in the study. The mean number of groups attended was five out of six total (standard deviation=2), and the mean total minutes attended were 139 out of 180 possible (standard deviation=55). Fifty percent had perfect attendance. CONCLUSIONS Older adults with schizophrenia need effective physical activity programs. Adherence to our program suggests that videogames that use the Kinect for Xbox 360 game system are an innovative way to make physical activity accessible to this population.
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Affiliation(s)
- Heather Leutwyler
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California
| | - Erin M Hubbard
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California
| | - Glenna A Dowling
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California
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