Peer support and mobile health technology targeting obesity-related cardiovascular risk in young adults with serious mental illness: Protocol for a randomized controlled trial

The effect of exercise on cognition and clinical symptoms of patients with schizophrenia: A systematic review of randomized controlled trial

Physical activity has been viewed as a potential non-pharmacological therapeutic strategy to improve the clinical symptoms and neurocognitive deficits in patients with schizophrenia. However, there are various types of physical activities, and different exercise prescriptions might produce inconsistent benefits. Thus, this study aimed to conduct a systematic review of exercise interventions for patients with schizophrenia, clarifying the benefits of these interventions on cognitive function and clinical symptoms. This review encompasses six electronic databases, with inclusion criteria including randomized controlled trial designs, participants with schizophrenia, and a comprehensive exercise intervention program. Twenty-seven studies met the inclusion criteria, incorporating data from 1549 patients with schizophrenia. The results highlight that when comparing the exercise intervention group to the non-intervention control group, patients with schizophrenia showed significant improvement in negative symptoms. Structured exercise interventions can help improve the negative symptoms of schizophrenia, filling the gaps where medication falls short. Regarding functional outcomes, exercise interventions aid in enhancing the overall functionality (psychological, social, occupational) of individuals with schizophrenia. The improvement is largely tied to the boost in physical fitness that exercise provides. Based on current findings, exercise interventions assist in enhancing cognitive function in patients with schizophrenia. Notably, significant improvements are observed in higher-order cognitive functions, including processing speed, attention, and working memory. It is recommended to engage in moderate-intensity exercises at least three times a week, with each session lasting a minimum of 30min. Well-structured exercise interventions contribute to enhancing the negative symptoms and cognitive functions in patients with schizophrenia.

Factors influencing engagement in in-person and remotely delivered lifestyle interventions for young adults with serious mental illness: A qualitative study

AIM

Young adults (ages 18-35) are underrepresented in lifestyle interventions for people with serious mental illness (SMI), such as schizophrenia, bipolar disorder, and severe depression, and little is known about factors influencing their engagement in these programmes. This qualitative study examined factors affecting engagement amongst young adults with SMI who were enrolled in a lifestyle intervention trial at community mental health centres.

METHODS

Seventeen young adults with SMI participated in this qualitative study. Participants were drawn from a 12-month randomized controlled trial (n = 150) comparing an in-person group lifestyle intervention augmented with mobile health technology (PeerFIT) to one-on-one personalized remote health coaching (BEAT) using purposive sampling. The 17 participants completed semi-structured qualitative interviews at post-intervention to explore their perceived benefits of the intervention and factors impacting engagement. We used a team-based descriptive qualitative approach to code transcripts and identify themes in the data.

RESULTS

Participants across both interventions reported experiencing improved ability to engage in health behaviour change. Participants described managing psychosocial stressors and family and other responsibilities that limited their ability to attend in-person PeerFIT sessions. The remote and flexible BEAT remote health coaching intervention appeared to facilitate engagement even in the context of challenging life circumstances.

CONCLUSIONS

Remotely delivered lifestyle interventions can facilitate engagement amongst young adults with SMI navigating social stressors.

30-year Cardiovascular Disease Risk for Young Adults with Serious Mental Illness

Objective

To estimate 30-year CVD risk and modifiable risk factors in young adults with serious mental illness (SMI) versus those without, and assess variations in CVD risk by race, ethnicity, and sex.

Method

In this cross-sectional study, we estimated and compared the Framingham 30-year CVD risk score and individual modifiable CVD risk factors in young adult (20-39 years) primary care patients with and without SMI at two US healthcare systems (January 2016-Septemeber 2018). Interaction terms assessed whether the SMI-risk association differed across demographic groups.

Results

Covariate-adjusted 30-year CVD risk was significantly higher for those with (n=4228) versus those without (n=155,363) SMI (RR 1.28, 95% CI [1.26, 1.30]). Patients with SMI had higher rates of hypertension (OR 2.02 [1.7, 2.39]), diabetes (OR 3.14 [2.59, 3.82]), obesity (OR 1.93 [1.8, 2.07]), and smoking (OR 4.94 [4.6, 5.36]). The increased 30-year CVD risk associated with SMI varied significantly by race and sex: there was an 8% higher risk in Black compared to White patients (RR 1.08, [1.04, 1.12]) and a 9% lower risk in men compared to women (RR 0.91 [0.88, 0.94]).

Conclusions

Young adults with SMI are at increased 30-year risk of CVD, and further disparities exist for Black individuals and women.

Informing the development of the coaching online and community health (COACH) program: a qualitative study of clubhouse members living with serious mental illness

Health and wellness interventions addressing risk factors for early mortality among individuals with serious mental illness have demonstrated success and can be further augmented with digital technology. These programs may be suitable for delivery in psychosocial rehabilitation clubhouses, especially given many services have transitioned to digital platforms during the pandemic. This qualitative study aimed to: (a) explore clubhouse members' experiences engaging with the virtual clubhouse platform, and their preferences for accessing digital wellness and health promotion content; and, (b) gauge members' interest in an online peer-driven lifestyle intervention and their suggestions for program design. This study was guided by a community-based participatory action research framework. Ten focus groups were conducted with clubhouse members. Focus groups were coded and analyzed thematically by trained clubhouse members and the research team. Thirty-three members participated in the focus groups. Participants expressed the importance of having technical support from staff; that one-on-one support and consistent communication are important to keep them engaged in health and wellness programming; and described mixed views about use of the virtual platform, but generally were open to engaging in lifestyle intervention programming virtually. Participants who joined the clubhouse during the pandemic expressed feeling overwhelmed by in-person gatherings, and were especially interested in opportunities for remote participation. This study can inform health and wellness programming for delivery on the virtual clubhouse platform for members. The taxonomy of codes, created to generate a framework with recommendations, will inform the design of a virtual health and wellness intervention.

Factors associated with weight gain prevention in young adults with serious mental illness

AIM

The purpose of this study was to examine factors associated with weight gain prevention among young adults with serious mental illness who participated in the Fit Forward randomized controlled trial evaluating lifestyle interventions adapted for this high-risk group. The aims were to: (1) examine baseline differences between participants that gained weight and those that lost or maintained weight at six and 12 months, and (2) evaluate whether changes in weight control strategies were associated with weight gain prevention at 6 and 12 months.

METHODS

This study was a secondary analysis of the Fit Forward Study. Participants were young adults (age 18-35) with a serious mental illness and a body mass index in the overweight or obese range. Participants completed assessments at baseline and 6 and 12 months. t-Tests and chi-squared tests were used to examine baseline differences between those that gained weight and those that lost/maintained weight. Logistic regression was used to evaluate whether changes in weight control strategies were associated with weight gain prevention in the sample overall.

RESULTS

Lower baseline BMI was significantly associated with weight gain prevention at six and 12 months. Greater increases in weight control strategies total score and psychological coping subscale were significantly associated with weight gain prevention at six and 12 months.

CONCLUSIONS

Weight control strategies, particularly psychological coping tools that support positive thinking and reduce negative self-talk should be considered as core strategies in healthy lifestyle interventions aimed at preventing weight gain in young adults with serious mental illness.

Wearables in Schizophrenia: Update on Current and Future Clinical Applications

Schizophrenia affects 1% of the world population and is associated with a reduction in life expectancy of 20 years. The increasing prevalence of both consumer technology and clinical-grade wearable technology offers new metrics to guide clinical decision-making remotely and in real time. Herein, recent literature is reviewed to determine the potential utility of wearables in schizophrenia, including their utility in diagnosis, first-episode psychosis, and relapse prevention and their acceptability to patients. Several studies have further confirmed the validity of various devices in their ability to track sleep—an especially useful metric in schizophrenia, as sleep disturbances may be predictive of disease onset or the acute worsening of psychotic symptoms. Through machine learning, wearable-obtained heart rate and motor activity were used to differentiate between controls and patients with schizophrenia. Wearables can capture the autonomic dysregulation that has been detected when patients are actively experiencing paranoia, hallucinations, or delusions. Multiple platforms are currently being researched, such as Health Outcomes Through Positive Engagement and Self-Empowerment, Mobile Therapeutic Attention for Treatment-Resistant Schizophrenia, and Sleepsight, that may ultimately link patient data to clinicians. The future is bright for wearables in schizophrenia, as the recent literature exemplifies their potential to offer real-time insights to guide diagnosis and management.

Group Lifestyle Intervention With Mobile Health for Young Adults With Serious Mental Illness: A Randomized Controlled Trial

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.

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

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.

Participant Experiences With a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness

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.

Psychometric Properties of the Persian Version of the Weight Control Strategies Scale (WCSS)

Objective: The purpose of the present study was to examine the validity and reliability of the Persian version of the Weight Control Strategies Scale among individuals engaged in weight loss or weight maintenance.

Method: This descriptive study conducted from October 2019 to February 2020 on social media networks. A total of 420 men and women were selected using consecutive sampling. They completed the Persian version of the Weight Control Strategies Scale and the Self-Compassion Scale. Data were analyzed using descriptive statistics, Cronbach’s α, confirmatory factor analysis, and Pearson product-moment correlations.

Results: Internal consistency for the total score of the Persian version of Weight Control Strategies Scale was excellent and acceptable to good for all 4 subscales (in all cases over α = 0.70). Confirmatory factor analysis supported the factor structure of the original model of the scale, but, it was different from the model at the item level. Moreover, the Persian version of Weight Control Strategies Scale had good convergent validity.

Conclusion: Psychometrically speaking, the Persian version of the Weight Control Strategies Scale is a valid and reliable tool to assess the psychological and behavioral profile of individuals engaging in losing or maintaining weight, both for clinical and research purposes.

The Acceptability and Feasibility of Using Text Messaging to Support the Delivery of Physical Health Care in those Suffering from a Psychotic Disorder: a Review of the Literature

Those suffering with serious mental illness (SMI), such as psychotic disorders, experience life expectancy 15 years shorter than the general population. Cardiovascular disease is the biggest cause of death in those with psychotic disease and many risk factors may be limited by healthy lifestyle choices. Text messaging interventions represent mobile health (mHealth), a nascent way to deliver physical health care to those suffering with a psychotic disorder. This paper aims to review the literature on the feasibility of text messaging to support the delivery of physical health care in those with a psychotic disorder. A thorough electronic database literature review of Medline via Ovid, Embase, APA Psycinfo, Scopus, Cochrane and Web of Science was conducted. Articles were included if text messaging was used as an intervention targeting the physical health of patients with psychotic disorders. A final sample of 11 articles satisfied the eligibility criteria, of which, 3 were ongoing randomised controlled trials. Of the 8 completed trials, all demonstrated the promising feasibility of text messaging, assessed via quotes, conversation samples, response rates, questionnaires or directly based on physical results. 36% of studies analysed those with schizophrenia or schizoaffective disorder, 55% with SMI and 9% with schizophrenia and psychotic disorders, mood disorders or anxiety disorders. Text messaging was used as motivation or reminders (91%), service delivery (27%) or social support (27%) with studies targeting multiple themes simultaneously. This review highlights compelling evidence for the feasibility of text messaging for improvement of physical health in those suffering with psychotic disorders.

On How Chronic Conditions Affect the Patient-AI Interaction: A Literature Review

Background: Across the globe, managing chronic diseases has been recognized as a challenge for patients and healthcare providers. The state of the art in managing chronic conditions requires not only responding to the clinical needs of the patient, but also guaranteeing a comfortable state of wellbeing for them, despite living with the disease. This demands mutual effort between the patient and the physician in constantly collecting data, monitoring, and understanding the disease. The advent of artificial intelligence has made this process easier. However, studies have rarely attempted to analyze how the different artificial intelligence based health coaching systems are used to manage different types of chronic conditions. Objective: Throughout this grounded theory literature review, we aim to provide an overview for the features that characterize artificial intelligence based health coaching systems used by patients with chronic diseases. Methods: During our search and paper selection process process, we use three bibliographic libraries (PubMed, IEEE Xplore, and ACM Digital Library). Using the grounded theory, we extract overarching themes for the artificial intelligence based health coaching systems. These systems are then classified according to their role, platform, type of interaction with the patient, as well as targeted chronic conditions. Of 869 citations retrieved, 31 unique studies are included in this review. Results: The included studies assess 14 different chronic conditions. Common roles for AI-based health coaching systems are: developing adherence, informing, motivating, reminding, preventing, building a care network, and entertaining. Health coaching systems combine the aforementioned roles to cater to the needs of the patients. The combinations of these roles differ between multilateral, unilateral, opposing bilateral, complementing bilateral, one-role-missing, and the blurred role combinations. Conclusion: Clinical solutions and research related to artificial intelligence based health coaching systems are very limited. Clear guidelines to help develop artificial intelligence-based health coaching systems are still blurred. This grounded theory literature review attempted to shed the light on the research and development requirements for an effective health coaching system intended for patients with chronic conditions. Researchers are recommended to use this review to identify the most suitable role combination for an effective health coaching system development.

Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

Social media platforms are popular venues for sharing personal experiences, seeking information, and offering peer-to-peer support among individuals living with mental illness. With significant shortfalls in the availability, quality, and reach of evidence-based mental health services across the United States and globally, social media platforms may afford new opportunities to bridge this gap. However, caution is warranted, as numerous studies highlight risks of social media use for mental health. In this commentary, we consider the role of social media as a potentially viable intervention platform for offering support to persons with mental disorders, promoting engagement and retention in care, and enhancing existing mental health services. Specifically, we summarize current research on the use of social media among mental health service users, and early efforts using social media for the delivery of evidence-based programs. We also review the risks, potential harms, and necessary safety precautions with using social media for mental health. To conclude, we explore opportunities using data science and machine learning, for example by leveraging social media for detecting mental disorders and developing predictive models aimed at characterizing the aetiology and progression of mental disorders. These various efforts using social media, as summarized in this commentary, hold promise for improving the lives of individuals living with mental disorders.

The Future of Peer Support in Digital Psychiatry: Promise, Progress, and Opportunities

PURPOSE

This selective review highlights promising findings and future opportunities relevant to digital peer support services. This review considered literature published in peer-reviewed scholarly journals within the past 36 months.

RECENT FINDINGS

Digital peer support spans multiple technology modalities: peer-delivered and smartphone-supported interventions, peer-supported asynchronous technology, artificial peer support, informal peer-to-peer support via social media, video games, and virtual worlds. Digital peer support is an emerging area of research that shows promise in improving mental health symptoms, medical and psychiatric self-management skill development, social functioning, hope, and empowerment.

SUMMARY

As the science of peer support in digital psychiatry advances, peer support specialists will likely have an increasingly important role in the mental health workforce-from providing evidence-based, fidelity-adherent interventions to expanding their reach to vulnerable populations and communities.

Adolescents' Use of Digital Technologies and Preferences for Mobile Health Coaching in Public Mental Health Settings

Objective: Youth with mental illnesses often engage in unhealthy behaviors associated with early mortality from physical diseases in adulthood, but interventions to support positive health behaviors are rarely offered as part of routine mental health care for this group. Digital health technology that is desirable, accessible, and affordable has the potential to address health behaviors in public mental health settings where many adolescents with severe mental health problems receive care. The aims of this study were to examine how adolescents receiving public mental health services use digital technology and social media and to explore their preferences using technology to support health and wellness.

Methods: Using a convergent parallel mixed methods design, we surveyed adolescents ages 13–18 from four community mental health centers in one state and conducted focus group interviews to explore their perspectives on using digital technology and social media to receive health coaching and connect with peers to support healthy behaviors. The survey and focus group data were merged to inform the future development of a digital health intervention for adolescents receiving public mental health services.

Results: Of 121 survey respondents (mean age 15.2, SD = 1.5), 92% had a cell phone, 79% had a smartphone, 90% used text messaging, and 98% used social media. Focus group interviews revealed that adolescents were interested in receiving strengths-based mobile health coaching, and they preferred structured online peer-to-peer interactions in which a professional moderator promotes positive connections and adherence to privacy guidelines.

Conclusions: Adolescents receiving public mental health services in this study had access to smartphones and were frequent social media users. These data suggest that digital health interventions to promote health and wellness among adolescents may be scalable in community mental health settings. Adolescent participants suggested that digital health interventions for this group should focus on strengths and online peer support for health promotion should include a professional moderator to foster and manage peer-to-peer interactions.

Peer Support: a Human Factor to Enhance Engagement in Digital Health Behavior Change Interventions

The purpose of this report is to develop a theoretical model based on empirical evidence that can serve as a foundation for the science of peer-support factors that facilitate engagement in digital health interventions for people with serious mental illness (SMI). A review of the literature on how peer-support specialist interaction with consumers with SMI in digital health behavior change interventions enhances engagement. Unlike relationships with other health providers, peer-to-consumer relationships are based on reciprocal accountability -meaning that peer-support specialists and consumer mutually help and learn from each other. Under the recovery model of mental illness, reciprocal accountability suggests autonomy, flexible expectations, shared lived experience, and bonding influence engagement in digital interventions. Separate yet related components of reciprocal accountability in the context of digital health intervention engagement include (1) goal setting, (2) task agreement, and (3) bonding. Hope and sense of belonging are hypothesized moderators of peer-support factors in digital health interventions. Peer-support factors help people with SMI learn to live sucessfully both in the clinic and community. Peer-support specialists add value and complement traditional mental health treatment through their professional training and lived experience with a mental illness. The proposed model is a pioneering step towards understanding how peer-support factors impact engagement in digital health behavior change interventions among people with a lived experience of SMI. The model presents proposed factors underlying the reciprocal accountability processes in the context of digital health intervention engagement. This model and related support factors can be used to examine or identify research questions and hypotheses.