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Hui TT, Garvey L, Olasoji M. Perspectives of mental health clinicians on physical health of young people with early psychosis. Int J Ment Health Nurs 2024; 33:649-659. [PMID: 38012093 DOI: 10.1111/inm.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
The aim of this study is to explore the views and understanding of youth mental health clinicians with regard to the physical health of young people with early psychosis and their perspectives on lifestyle interventions improving the health and well-being of young people with early psychosis. Physical health disparities leading to premature mortality among people with mental illness are well evident in the literature. Mental health and physical health are directly correlated. The risk of poor physical health often begins before the onset of mental ill health. Young people with early psychosis are highly susceptible to poor physical health. A co-designed integrated approach focusing on early prevention and intervention in overall well-being and health is imminent for this targeted population to prevent poor physical health trajectory across the lifespan. Ten clinicians were recruited and participated in this study through semi-structured interviews. Five themes were identified: (i) Impact of early psychosis, (ii) Focus of care, (iii) Conversations around physical health, (iv) Co-location of specialist roles and (v) Health literacy. The findings of this study confirm the dimensional impact of early psychosis on the well-being and health of young people through the vicious cycle of early psychosis. Promotion of health literacy along with social connectedness and elements of self-determination, as well as having a prime focus on the individuals' experience in the journey of health promotion through participation in lifestyle interventions, has been identified as critically prominent.
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Affiliation(s)
- Ting Ting Hui
- Federation University Australia, Berwick, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Loretta Garvey
- Federation University Australia, Berwick, Victoria, Australia
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology Australia, Hawthorn, Victoria, Australia
| | - Michael Olasoji
- Federation University Australia, Berwick, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
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2
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Ingram I, Deane FP, Baker AL, Townsend CJ, Collins CE, Callister R, Chenhall R, Ivers R, Kelly PJ. The health of people attending residential treatment for alcohol and other drug use: Prevalence of and risks for major lifestyle diseases. Drug Alcohol Rev 2023; 42:1723-1732. [PMID: 37715714 DOI: 10.1111/dar.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Cardiovascular disease and cancers are the leading cause of mortality amongst people accessing treatment for alcohol and other drug use. The current study aimed to examine risk factors for chronic disease amongst people attending residential alcohol and other drug treatment services. METHODS Participants (N = 325) were attending residential alcohol and other drug treatment services across Australia. Diabetes and cardiovascular disease risk scores were calculated using established risk estimation algorithms. Differences in existing health conditions, risk factors for chronic diseases and risk algorithms were calculated for males and females. RESULTS In addition to alcohol and other drug use (including tobacco use), 95% of the sample had at least one other risk factor for chronic disease. Of participants not already diagnosed, 36% were at a high risk of developing type 2 diabetes and 11% had a high risk of developing cardiovascular disease. The heart age of participants was 11 years older than actual age (Mage = 40.63, Mheart age = 52.41). Males had a higher cardiovascular disease risk than females. DISCUSSION AND CONCLUSIONS A large proportion of people accessing residential alcohol and other drug treatment were at risk of chronic disease. Future research is needed that uses objective indicators of physical health. Such research will help to develop our understanding of prevention and intervention initiatives that could be adopted by treatment providers to improve the physical health of their consumers.
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Affiliation(s)
- Isabella Ingram
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Camilla J Townsend
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Food and Nutrition Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Richard Chenhall
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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3
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Bradley T, Campbell E, Dray J, Bartlem K, Wye P, Hanly G, Gibson L, Fehily C, Bailey J, Wynne O, Colyvas K, Bowman J. Systematic review of lifestyle interventions to improve weight, physical activity and diet among people with a mental health condition. Syst Rev 2022; 11:198. [PMID: 36085250 PMCID: PMC9462072 DOI: 10.1186/s13643-022-02067-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a mental health condition experience an elevated risk of chronic disease and greater prevalence of health and behaviours. Lifestyle interventions aim to reduce this risk by modifying health behaviours such as physical activity and diet. Previous reviews exploring the efficacy of such interventions for this group have typically limited inclusion to individuals with severe mental illness (SMI), with a focus of impact on weight. This review assessed the efficacy of lifestyle interventions delivered in community or outpatient settings to people with any mental health condition, on weight, physical activity and diet. METHODS Eligible studies were randomised or cluster-randomised controlled trials published between January 1999 and February 2019 aiming to improve weight, physical activity or diet, for people with any mental health condition. Two reviewers independently completed study screening, data extraction and assessment of methodological quality. Primary outcome measures were weight, physical activity and diet. Secondary outcome measures were body mass index (BMI), waist circumference, sedentary behaviour and mental health. Where possible, meta-analyses were conducted. Narrative synthesis using vote counting based on direction of effect was used where studies were not amenable to meta-analysis. RESULTS Fifty-seven studies were included (49 SMI only), with 46 contributing to meta-analyses. Meta-analyses revealed significant (< 0.05) effect of interventions on mean weight loss (-1.42 kg), achieving 5% weight loss (OR 2.48), weight maintenance (-2.05 kg), physical activity (IPAQ MET minutes: 226.82) and daily vegetable serves (0.51), but not on fruit serves (0.01). Significant effects were also seen for secondary outcomes of BMI (-0.48 units) and waist circumference (-0.87cm), but not mental health (depression: SMD -0.03; anxiety: SMD -0.49; severity of psychological symptoms: SMD 0.72). Studies reporting sedentary behaviour were not able to be meta-analysed. Most trials had high risk of bias, quality of evidence for weight and physical activity were moderate, while quality of evidence for diet was low. CONCLUSION Lifestyle interventions delivered to people with a mental health condition made statistically significant improvements to weight, BMI, waist circumference, vegetable serves and physical activity. Further high-quality trials with greater consistency in measurement and reporting of outcomes are needed to better understand the impact of lifestyle interventions on physical activity, diet, sedentary behaviour and mental health and to understand impact on subgroups. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019137197.
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Affiliation(s)
- Tegan Bradley
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Julia Dray
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kate Bartlem
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Grace Hanly
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Lauren Gibson
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Caitlin Fehily
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Jacqueline Bailey
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Olivia Wynne
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Kim Colyvas
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Jenny Bowman
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
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4
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Baker AL, Forbes E, Pohlman S, McCarter K. Behavioral Interventions to Reduce Cardiovascular Risk Among People with Severe Mental Disorder. Annu Rev Clin Psychol 2022; 18:99-124. [PMID: 35175861 DOI: 10.1146/annurev-clinpsy-072720-012042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among people with severe mental disorder (SMD). CVD risk factors occur at the individual, health system, and socio-environmental levels and contribute not only to high rates of CVD but also to worsening mental health. While acknowledging this wider context, this review focuses on behavioral interventions for seven CVD risk behaviors-smoking, physical inactivity, excessive alcohol consumption, low fruit and vegetable intake, inadequate sleep, poor social participation, and poor medication adherence-that are common among people with SMD. We survey recent meta-reviews of the literature and then review additional key studies to provide clinical recommendations for behavioral interventions to reduce CVD risk among people with SMD. A transdiagnostic psychological approach from the start of mental health treatment, drawing upon multidisciplinary expertise to address multiple risk behaviors, is recommended. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia;
| | - Erin Forbes
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia;
| | - Sonja Pohlman
- School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kristen McCarter
- School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
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5
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Diet Quality Indices Used in Australian and New Zealand Adults: A Systematic Review and Critical Appraisal. Nutrients 2020; 12:nu12123777. [PMID: 33317123 PMCID: PMC7763901 DOI: 10.3390/nu12123777] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/24/2022] Open
Abstract
Distilling the complexity of overall diet into a simple measure or summative score by data reduction methods has become a common practice in nutritional epidemiology. Recent reviews on diet quality indices (DQI) have highlighted the importance of sound construction criteria and validation. The aim of this current review was to identify and critically appraise all DQI used within Australian and New Zealand adult populations. Twenty-five existing DQI were identified by electronic searching in Medline and hand searching of reference lists. DQI were constructed based on the respective national dietary guidelines and condition-specific recommendations. For preferable features of DQI, six captured the dimensions of adequacy, moderation and balance; five had a nested structure; 12 consisted of foods, food groups and nutrients; 11 used metric scoring systems and most of those with metric scales used normative cutoff points. Food frequency questionnaires, either alone or with other methods, were the most common dietary assessment method used in 20 DQI. For evaluation of DQI, construct validity and relative validity are reported. Based on our critical appraisal, Dietary Guideline Index (DGI), Dietary Guideline Index-2013 (DGI-2013), Total Diet Score (TDS), Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), and Aussie-Diet Quality Index (Aussie-DQI) were the preferred DQI used in Australian adults according to dimension, indicator selection, scoring criteria and evaluation. Further work is needed to enhance the construction of all Australian and New Zealand DQI, especially in terms of dimension and structure, for alignment with recommended construction criteria.
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Fehily C, Latter J, Bartlem K, Wiggers J, Bradley T, Rissel C, Reakes K, Reid K, Browning E, Bowman J. Awareness and use of telephone-based behaviour change support services among clients of a community mental health service. Aust N Z J Public Health 2020; 44:482-488. [PMID: 33104282 DOI: 10.1111/1753-6405.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/01/2020] [Accepted: 08/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the prevalence of, and factors associated with, awareness and use of telephone-based behaviour change support services among clients of a community mental health service. METHODS Adult clients (n=375) of one Australian community mental health service completed a telephone interview and self-reported not meeting Australian National Guidelines for smoking, nutrition, alcohol consumption and/or physical activity. Descriptive statistics summarised awareness and use of the New South Wales Quitline® and Get Healthy Service® for participants with lifestyle risk factors addressed by each service. Chi-squares and logistic regressions explored associations between client characteristics, and service awareness and use. RESULTS Awareness (16.1%) and use (1.9%) of the Get Healthy Service was lower than that of Quitline (89.1%; 18.1%). Television was the most common source of awareness (39.7% Get Healthy Service; 74.0% Quitline). In the regression models, persons in a relationship were more likely to have heard of the Get Healthy Service (OR:2.19, CI:1.15-4.18), and persons aged 36-50 were more likely to have used the Quitline (OR:5.22, CI:1.17-23.37). CONCLUSIONS Opportunities exist for increasing awareness and use of both services, particularly the Get Healthy Service, among clients of community mental health services. Implications for public health: Strategies to optimise reach for this population group are recommended.
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Affiliation(s)
- Caitlin Fehily
- School of Psychology, Faculty of Science, The University of Newcastle, New South Wales.,The Australian Prevention Partnership Centre (TAPPC), Sax Institute, New South Wales
| | - Joanna Latter
- School of Psychology, Faculty of Science, The University of Newcastle, New South Wales
| | - Kate Bartlem
- School of Psychology, Faculty of Science, The University of Newcastle, New South Wales.,The Australian Prevention Partnership Centre (TAPPC), Sax Institute, New South Wales
| | - John Wiggers
- Population Health, Hunter New England Local Health District, New South Wales.,School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, New South Wales
| | - Tegan Bradley
- School of Psychology, Faculty of Science, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, Clinical Research Centre, New South Wales
| | - Chris Rissel
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, New South Wales.,NSW Office of Preventive Health, New South Wales
| | | | - Kate Reid
- NSW Office of Preventive Health, New South Wales
| | - Ellen Browning
- School of Psychology, Faculty of Science, The University of Newcastle, New South Wales
| | - Jenny Bowman
- School of Psychology, Faculty of Science, The University of Newcastle, New South Wales.,The Australian Prevention Partnership Centre (TAPPC), Sax Institute, New South Wales
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7
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Cherak SJ, Fiest KM, VanderSluis L, Basualdo-Hammond C, Lorenzetti DL, Buhler S, Stadnyk J, Driedger L, Hards L, Gramlich L, Fenton TR. Nutrition interventions in populations with mental health conditions: a scoping review. Appl Physiol Nutr Metab 2020; 45:687-697. [PMID: 32496807 DOI: 10.1139/apnm-2019-0683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nutrition is a modifiable factor for intervention in mental disorders. This scoping review characterized nutrition intervention research in mental disorders. A 3-category framework characterized nutrition interventions: Guide (e.g., counselling), Provide (e.g., food provisions), and Add (e.g., supplementation). Nutrition interventions were classified as single-component (e.g., Guide) or complex (e.g., Guide-Provide). Sixty-nine trials met inclusion criteria, 96% were randomized controlled trials. Most commonly diagnosed mental disorders were depressive disorder (i.e., persistent) or major depressive disorder (n = 39), schizophrenia (n = 17), and other psychotic disorders (n = 13). Few trials included patients with anxiety disorders (n = 2) or bipolar disorders (n = 3). Several trials (n = 15, 22%) assessed and implemented nutrition interventions to improve dietary patterns, of which 11 (73%) reported statistically significant and clinically important positive effects of nutrition interventions on mental disorders. The majority of the trials (n = 61, 90%) investigated supplementation, most commonly adding essential fatty acids, vitamins, or minerals. The majority (n = 48, 70%) reported either statistically significant or clinically important effect and 31 (51%) reported both. Though most interventions led to statistically significant improvements, trials were heterogeneous for targeted mental disorders, nutrition interventions, and outcomes assessed. Given considerable heterogeneity, further research from robust and clinically relevant trials is required to support high-quality health care with effective nutrition interventions. Novelty Future research on whole-diet interventions powered to detect changes in mental health outcomes as primary objectives is needed. Dietitians may be an opportunity to improve feasibility and efficacy of nutrition interventions for mental disorder patients. Dietitians may be of value to educate mental health practitioners on the importance of nutrition.
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Affiliation(s)
- Stephana J Cherak
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Laura VanderSluis
- Department of Agriculture, Food, and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | | | - Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada.,Health Sciences Library, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Sue Buhler
- Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Janet Stadnyk
- Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | | | - Lori Hards
- Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Leah Gramlich
- Department of Agriculture, Food, and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Tanis R Fenton
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada.,Alberta Health Services, Edmonton, AB T5J 3E4, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
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8
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Bradley T, Bartlem K, Campbell E, Wye P, Rissel C, Reid K, Regan T, Bailey J, Bowman J. Characteristics of participants utilising a telephone-based coaching service for chronic disease health risk behaviours: A retrospective examination comparing those with and without a mental health condition. Prev Med Rep 2020; 19:101123. [PMID: 32477854 PMCID: PMC7248287 DOI: 10.1016/j.pmedr.2020.101123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/24/2020] [Accepted: 05/09/2020] [Indexed: 11/17/2022] Open
Abstract
People with mental health conditions engage with health coaching phone services. The prevalence and extent of some health risk behaviours is higher in this group. Confidence in ability to change health risk behaviours is lower in this group.
The NSW Get Healthy Service® (GHS) is a free telephone-based coaching service in NSW, Australia, which supports behaviour change around healthy eating and physical activity. The aims of this study were to 1) assess the proportion of coaching participants within GHS who report having had a mental health condition, and 2) describe and compare the health risk profiles and confidence for behaviour change of coaching participants with and without a mental health condition. Secondary data analysis was conducted on information collected via participant self-report as a part of the coaching process for 11,925 participants who enrolled in a GHS coaching program for the first time between January 2015 and December 2017. Twenty six percent (n = 3106) of participants reported having had a significant mental health condition that required treatment from a health professional. Participants who reported a mental health condition were significantly less likely (54%) to be meeting guidelines for physical activity than participants without a mental health condition (64%); more likely to be overweight/obese (89%) compared to those without (81%); and reported lower confidence for changing exercise, nutrition and weight. There were no significant differences in proportions meeting fruit or vegetable intake recommendations. People with a mental health condition represent approximately a quarter of GHS participants. This group of participants presented higher levels of health risks and expressed lower confidence in behaviour change than program participants without such a condition. Future service planning and development may consider this variation in participant profiles.
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Affiliation(s)
- Tegan Bradley
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Kate Bartlem
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Elizabeth Campbell
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Chris Rissel
- NSW Office of Preventive Health, Liverpool Hospital, Don Everett Building, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Kate Reid
- NSW Office of Preventive Health, Liverpool Hospital, Don Everett Building, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Timothy Regan
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Jacqueline Bailey
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Jenny Bowman
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
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9
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Kelly PJ, Baker AL, Fagan NL, Turner A, Deane F, McKetin R, Callister R, Collins C, Ingram I, Wolstencroft K, Townsend C, Osborne BA, Zimmermann A. Better Health Choices: Feasability and preliminary effectiveness of a peer delivered healthy lifestyle intervention in a community mental health setting. Addict Behav 2020; 103:106249. [PMID: 31881407 DOI: 10.1016/j.addbeh.2019.106249] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/29/2019] [Accepted: 11/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND To reduce smoking and improve other health behaviours of people living with severe mental illness, healthy lifestyle interventions have been recommended. One approach to improving the availability of these types of interventions is to utilise the mental health peer workforce. The current study aimed to evaluate the feasibility of peer-workers facilitating a telephone delivered healthy lifestyle intervention within community based mental health settings. The study also examined preliminary outcomes of the intervention. METHODS The study was conducted as a randomised controlled feasibility trial. In addition to treatment as usual, participants randomised to the Treatment Condition were offered BHC. This was an 8-session telephone delivered coaching intervention that encouraged participants to decrease their smoking, increase their intake of fruit and vegetables, and reduce their leisure screen time. Participants in the waitlist Control Condition continued to complete treatment as usual. All participants were engaged with Neami National, an Australian community mental health organisation. Peer-workers were also current employees of Neami National. RESULTS Forty-three participants were recruited. The average number of sessions completed by participants in the Treatment Condition was 5.7 (SD = 2.6; out of 8-sessions). Seventeen participants (77%) completed at least half of the sessions, and nine participants (40%) completed all eight sessions. Participant satisfaction was high, with all participants followed up rating the quality of the service they received as 'good' or 'excellent'. When compared to the Control Condition, people in the Treatment Condition demonstrated greater treatment effects on smoking and leisure screen time. There was only a negligible effect on servings of fruit and vegetable. CONCLUSIONS Results were promising regarding the feasibility of peer-workers delivering BHC. Good retention rates and high consumer satisfaction ratings in the Treatment Condition demonstrated that peer-workers were capable of delivering the intervention to the extent that consumers found it beneficial. The current results suggest that a sufficiently powered, peer delivered randomised controlled trial of BHC is warranted. STUDY REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR; Trial ID ACTRN123615000564550).
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10
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The Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet on Metabolic Syndrome in Hospitalized Schizophrenic Patients: A Randomized Controlled Trial. Nutrients 2019; 11:nu11122950. [PMID: 31817080 PMCID: PMC6950694 DOI: 10.3390/nu11122950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023] Open
Abstract
The relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and metabolic syndrome (MetS) in people with schizophrenia is unknown and remains to be investigated. Therefore, we have conducted a three-month parallel-group randomized controlled trial. Sixty-seven hospitalized schizophrenic patients with MetS [n = 33 in the intervention group (IG) and n = 34 in the control group (CG)] completed the intervention. The IG followed the DASH diet with the caloric restriction of approximately 1673.6 kJ/day (400 kcal/day) when compared to the standard hospital diet followed by the CG. Simultaneously, both groups participated in a nutrition counseling program. Anthropometric and biochemical parameters and blood pressure were measured at the baseline and after three months, while nutrient intakes during the intervention were assessed using three non-consecutive 24-hour dietary recalls. The analyses were carried out based on the per-protocol approach. At three months, the MetS prevalence significantly decreased in both the IG and the CG (75.8%, p = 0.002, and 67.7%, p = 0.0003, respectively; odds ratio = 0.9; 95% confidence interval = 0.43–1.87). No significant differences in the prevalence of MetS and its features were found between the groups.
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11
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Johnson HM, Sullivan-Vedder L, Kim K, McBride PE, Smith MA, LaMantia JN, Fink JT, Knutson Sinaise MR, Zeller LM, Lauver DR. Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial. Contemp Clin Trials 2019; 78:88-100. [PMID: 30677485 PMCID: PMC6387836 DOI: 10.1016/j.cct.2019.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 12/25/2022]
Abstract
Young adults (18-39 year-olds) with hypertension have a higher lifetime risk for cardiovascular disease. However, less than 50% of young adults achieve hypertension control in the United States. Hypertension self-management programs are recommended to improve control, but have been targeted to middle-aged and older populations. Young adults need hypertension self-management programs (i.e., home blood pressure monitoring and lifestyle modifications) tailored to their unique needs to lower blood pressure and reduce the risks and medication burden they may face over a lifetime. To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension. MyHEART is a patient-centered program, based upon the Self-Determination Theory, that uses evidence-based health behavior approaches to lower blood pressure. Therefore, the objective of this study is to evaluate MyHEART's impact on changes in systolic and diastolic blood pressure compared to usual care after 6 and 12 months in 310 geographically and racially/ethnically diverse young adults with uncontrolled hypertension. Secondary outcomes include MyHEART's impact on behavioral outcomes at 6 and 12 months, compared to usual clinical care (increased physical activity, decreased sodium intake) and to examine whether MyHEART's effects on self-management behavior are mediated through variables of perceived competence, autonomy, motivation, and activation (mediation outcomes). MyHEART is one of the first multicenter, randomized controlled hypertension trials tailored to young adults with primary care. The design and methodology will maximize the generalizability of this study. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03158051.
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Affiliation(s)
- Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Lisa Sullivan-Vedder
- Aurora Health Care Department of Family Medicine, Family Care Center, 1020 N 12(th) Street, Milwaukee, WI 53233, USA.
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, K6/420 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792-4675, USA.
| | - Patrick E McBride
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA.
| | - Maureen A Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut Street, 707 WARF Building, Madison, WI 53726, USA; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI 53715-1896, USA.
| | - Jamie N LaMantia
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Jennifer T Fink
- Department of Health Informatics and Administration, University of Wisconsin-Milwaukee College of Health Sciences, NWQ Building B, Suite #6455, 2025 E. Newport Avenue, Milwaukee, WI 53211-2906, USA.
| | - Megan R Knutson Sinaise
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Laura M Zeller
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Diane R Lauver
- School of Nursing, University of Wisconsin, Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI 53705, USA.
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12
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Clancy R, Lewin TJ, Bowman JA, Kelly BJ, Mullen AD, Flanagan K, Hazelton MJ. Providing physical health care for people accessing mental health services: Clinicians' perceptions of their role. Int J Ment Health Nurs 2019; 28:256-267. [PMID: 30152182 DOI: 10.1111/inm.12529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022]
Abstract
The prevalence of health risk behaviours and associated poor physical health is high in people with severe mental illness. Mental health service guidelines and policies stipulate that mental health services should address physical health of people who access services. This study reports results from a large, interdisciplinary, cross-sectional study exploring mental health clinicians' (n = 385) views of role legitimacy in physical health service provision. All disciplines reported that mental health clinicians have a role to play in addressing the physical health of consumers. Among mental health clinicians, psychiatrists and mental health nurses received higher endorsement than allied health clinicians in relation to the provision of physical health care, with primary care providers including general practitioners also ranking highly. As community mental health services routinely appoint allied health staff to case management roles, a challenge for services and a challenge for clinicians are to ensure that physical health and the effects of medication are monitored appropriately and systematically. Online and telephone support services received relatively lower endorsement. As the availability of nonface to face services increases, there is a need to explore their utility in this population and where appropriate promote their uptake.
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Affiliation(s)
- Richard Clancy
- Hunter New England Mental Health, Callaghan, NSW, Australia.,University of Newcastle, Callaghan, NSW, Australia
| | - Terry J Lewin
- Hunter New England Mental Health, Callaghan, NSW, Australia.,University of Newcastle, Callaghan, NSW, Australia
| | | | | | - Antony D Mullen
- Hunter New England Mental Health, Callaghan, NSW, Australia.,University of Newcastle, Callaghan, NSW, Australia
| | - Karen Flanagan
- Hunter New England Mental Health, Callaghan, NSW, Australia.,University of Newcastle, Callaghan, NSW, Australia
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13
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Ballbè M, Martínez C, Feliu A, Torres N, Nieva G, Pinet C, Raich A, Mondon S, Barrio P, Hernández-Ribas R, Vicens J, Costa S, Vilaplana J, Alaustre L, Vilalta E, Blanch R, Subirà S, Bruguera E, Suelves JM, Guydish J, Fernández E. Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial. Trials 2019; 20:38. [PMID: 30635072 PMCID: PMC6329054 DOI: 10.1186/s13063-018-3106-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/05/2018] [Indexed: 01/01/2023] Open
Abstract
Background Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. Methods A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. Discussion This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System. Trial registration ClinicalTrials.gov, NCT03230955. Registered on 24 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3106-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain. .,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain. .,Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, 08915 Sant Cugat del Valles, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain.
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - Núria Torres
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Gemma Nieva
- Smoking Cessation Unit, Addictive Behaviors Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Cristina Pinet
- Addictive Behaviors Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, C. San Antoni Ma Claret 167, 08025, Barcelona, Spain
| | - Antònia Raich
- Mental Health Department, Althaia Xarxa Assistencial Universitària, C. Dr. Llatjós s/n, Manresa, 08243, Barcelona, Spain
| | - Sílvia Mondon
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain
| | - Pablo Barrio
- Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain
| | - Rosa Hernández-Ribas
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain.,Alcohol Program, Psychiatry Department, Hospital Universitari de Bellvitge, Institut Català d'Oncologia, IDIBELL, CIBERSAM, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Jordi Vicens
- Psychiatry Department, Hestia Duran i Reynals, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Sílvia Costa
- Addictive Behaviors Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, C. San Antoni Ma Claret 167, 08025, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau, C. San Antoni Mª Claret 167, 08025, Barcelona, Spain
| | - Jordi Vilaplana
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Universitat de Lleida, Av. Alcalde Rovira Roure, 80, 25198, Lleida, Spain
| | - Laura Alaustre
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Eva Vilalta
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Roser Blanch
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Susana Subirà
- Psychiatry Department, Hestia Duran i Reynals, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Eugeni Bruguera
- Smoking Cessation Unit, Addictive Behaviors Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Josep Maria Suelves
- Public Health Agency of Catalonia, Health Department, Government of Catalonia, C. Roc Boronat 81-95, 08005, Barcelona, Spain
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa Llarga s/n, L'Hospitalet del Llobregat, 08907, Barcelona, Spain
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14
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Baker AL, Borland R, Bonevski B, Segan C, Turner A, Brophy L, McCarter K, Kelly PJ, Williams JM, Baird D, Attia J, Sweeney R, White SL, Filia S, Castle D. "Quitlink"-A Randomized Controlled Trial of Peer Worker Facilitated Quitline Support for Smokers Receiving Mental Health Services: Study Protocol. Front Psychiatry 2019; 10:124. [PMID: 30941063 PMCID: PMC6434698 DOI: 10.3389/fpsyt.2019.00124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/19/2019] [Indexed: 01/18/2023] Open
Abstract
Introduction: Although smokers with severe mental illnesses (SSMI) make quit attempts at comparable levels to other smokers, fewer are successful in achieving smoking cessation. Specialized smoking cessation treatments targeting their needs can be effective but have not been widely disseminated. Telephone delivered interventions, including by quitlines, show promise. However, few SSMI contact quitlines and few are referred to them by health professionals. Mental health peer workers can potentially play an important role in supporting smoking cessation. This study will apply a pragmatic model using peer workers to engage SSMI with a customized quitline service, forming the "Quitlink" intervention. Methods: A multi-center prospective, cluster-randomized, open, blinded endpoint (PROBE) trial. Over 3 years, 382 smokers will be recruited from mental health services in Victoria, Australia. Following completion of baseline assessment, a brief intervention will be delivered by a peer worker. Participants will then be randomly allocated either to no further intervention, or to be referred and contacted by the Victorian Quitline and offered a targeted 8-week cognitive behavioral intervention along with nicotine replacement therapy (NRT). Follow-up measures will be administered at 2-, 5-, and 8-months post-baseline. The primary outcome is 6 months continuous abstinence from end of treatment with biochemical verification. Secondary outcomes include 7-day point prevalence abstinence from smoking, increased quit attempts, and reductions in cigarettes per day, cravings and withdrawal, mental health symptoms, and other substance use, and improvements in quality of life. We will use a generalized linear mixed model (linear regression for continuous outcomes and logistic regression for dichotomous outcomes) to handle clustering and the repeated measures at baseline, 2-, 5-, and 8-months; individuals will be modeled as random effects, cluster as a random effect, and group assignment as a fixed effect. Discussion: This is the first rigorously designed RCT to evaluate a specialized quitline intervention accompanied by NRT among SSMI. The study will apply a pragmatic model to link SSMI to the Quitline, using peer workers, with the potential for wide dissemination. Clinical Trial Registration: Trial Registry: The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines. Trial Sponsor: University of Newcastle, NSW, Australia.
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Affiliation(s)
- Amanda L Baker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Ron Borland
- Cancer Council Victoria, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Billie Bonevski
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alyna Turner
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Mind Australia Limited, Melbourne, VIC, Australia.,School of Allied Health, Human Services and Sport, La Trobe University Melbourne, Melbourne, VIC, Australia
| | - Kristen McCarter
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and the School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Jill M Williams
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Donita Baird
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - John Attia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Rohan Sweeney
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | | | - Sacha Filia
- Cancer Council Victoria, Melbourne, VIC, Australia
| | - David Castle
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
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15
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Baker AL, Turner A, Beck A, Berry K, Haddock G, Kelly PJ, Bucci S. Telephone-delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder: systematic review. Psychol Med 2018; 48:2637-2657. [PMID: 29798730 PMCID: PMC6236444 DOI: 10.1017/s0033291718001125] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/04/2018] [Accepted: 04/06/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The mental and physical health of individuals with a psychotic illness are typically poor. Access to psychosocial interventions is important but currently limited. Telephone-delivered interventions may assist. In the current systematic review, we aim to summarise and critically analyse evidence for telephone-delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder, including (i) relapse, (ii) adherence to psychiatric medication and/or (iii) modifiable cardiovascular disease risk behaviours. METHODS Ten peer-reviewed and four grey literature databases were searched for English-language studies examining psychosocial telephone-delivered interventions targeting relapse, medication adherence and/or health behaviours in adults with a psychotic disorder. Study heterogeneity precluded meta-analyses. RESULTS Twenty trials [13 randomised controlled trials (RCTs)] were included, involving 2473 participants (relapse prevention = 867; medication adherence = 1273; and health behaviour = 333). Five of eight RCTs targeting relapse prevention and one of three targeting medication adherence reported at least 50% of outcomes in favour of the telephone-delivered intervention. The two health-behaviour RCTs found comparable levels of improvement across treatment conditions. CONCLUSIONS Although most interventions combined telephone and face-to-face delivery, there was evidence to support the benefit of entirely telephone-delivered interventions. Telephone interventions represent a potentially feasible and effective option for improving key health priorities among people with psychotic disorders. Further methodologically rigorous evaluations are warranted.
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Affiliation(s)
- Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Alyna Turner
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Alison Beck
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter J. Kelly
- Illawarra Institute for Mental Health, School of Psychology and the Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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16
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Ashdown-Franks G, Williams J, Vancampfort D, Firth J, Schuch F, Hubbard K, Craig T, Gaughran F, Stubbs B. Is it possible for people with severe mental illness to sit less and move more? A systematic review of interventions to increase physical activity or reduce sedentary behaviour. Schizophr Res 2018; 202:3-16. [PMID: 29980329 DOI: 10.1016/j.schres.2018.06.058] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/21/2018] [Accepted: 06/23/2018] [Indexed: 01/30/2023]
Abstract
Individuals with severe mental illness (SMI) (schizophrenia-spectrum, bipolar disorder and major depressive disorder) die 10-20 years prematurely due to physical disorders such as cardiovascular disease. Physical activity (PA) is effective in preventing and managing these conditions in the general population, however individuals with SMI engage in substantially less PA and more sedentary behaviour (SB) compared to healthy counterparts. Furthermore, the effectiveness of intervening to increase PA or reduce SB in SMI populations is unknown. Therefore, we systematically reviewed studies measuring changes in PA or SB following behavioural interventions in people with SMI. A systematic search of major databases was conducted from inception until 1/3/2018 for behavioural interventions reporting changes in PA or SB in people with SMI. From 3018 initial hits, 32 articles were eligible, including 16 controlled trials (CT's; Treatment n = 1025, Control n = 1162) and 16 uncontrolled trials (n = 655). Of 16 CTs, seven (47%) reported significant improvements in PA, although only one found changes with an objective measure. Of 16 uncontrolled trials, 3 (20%) found improvements in PA (one with objective measurement). No intervention study had a primary aim of changing SB, nor did any note changes in SB using an objective measure. In conclusion, there is inconsistent and low quality evidence to show that interventions can be effective in changing PA or SB in this population. Future robust randomized controlled trials, using objectively-measured PA/SB as the primary outcome, are required to determine which behavioural interventions are effective in improving the sedentary lifestyles associated with SMI. Systematic review registration- PROSPERO registration number CRD42017069399.
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Affiliation(s)
- Garcia Ashdown-Franks
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; Department of Exercise Sciences, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada.
| | - Julie Williams
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium and KU Leuven, University Psychiatric Center, Kortenberg, Belgium
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, University of Western Sydney, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Felipe Schuch
- Universidade La Salle (Unilasalle), Canoas, Brazil; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Kathryn Hubbard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - Tom Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
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17
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Thornton L, Kay-Lambkin F, Tebbutt B, Hanstock TL, Baker AL. A Mobile Phone-Based Healthy Lifestyle Monitoring Tool for People With Mental Health Problems (MyHealthPA): Development and Pilot Testing. JMIR Cardio 2018; 2:e10228. [PMID: 31758772 PMCID: PMC6857939 DOI: 10.2196/10228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/17/2018] [Accepted: 07/16/2018] [Indexed: 01/04/2023] Open
Abstract
Background People with mental health disorders live, on average, 20 years less than those without, often because of poor physical health including cardiovascular disease (CVD). Evidence-based interventions are required to reduce this lifespan gap. Objective This study aimed to develop, test, and evaluate a mobile phone–based lifestyle program (MyHealthPA) to help people with mental health problems improve key health risk behaviors and reduce their risk of CVD. Methods The development of MyHealthPA occurred in 3 stages: (1) scoping of the literature, (2) a survey (n=251) among people with and without the experience of mental health problems, and (3) program development informed by stages 1 and 2. A small pilot trial among young people with and without mental health disorders was also conducted. Participants completed a baseline assessment and were given access to the MyHealthPA program for a period of 8 weeks. They were then asked to complete an end-of-treatment assessment and a follow-up assessment 1 month later. Results In the study, 28 young people aged 19 to 25 years were recruited to the pilot trial. Of these, 12 (12/28, 43%) had been previously diagnosed with a mental illness. Overall, 12 participants (12/28, 43%) completed the end-of-treatment assessment and 6 (6/28, 21%) completed the follow-up assessment. Small improvements in fruit and vegetable consumption, level of physical activity, alcohol use, and mood were found between baseline and end of treatment and follow-up, particularly among people with experience of mental health issues. Most participants (history of mental illness: 4/7, 57%; no history of mental illness: 3/5, 60%) reported the program had above average usability; however, only 29% (2/7, no history of mental illness) to 40% (2/5, history of mental illness) of participants reported that they would like to use the program frequently and would recommend it to other young people. Participants also identified a number of ways in which the program could be improved. Conclusions This study describes the formative research and process of planning that formed the development of MyHealthPA and the evidence base underpinning the approach. The MyHealthPA program represents an innovative approach to CVD risk reduction among people with mental health problems. MyHealthPA appears to be an acceptable, easy-to-use, and potentially effective mHealth intervention to assist young people with mental illness to monitor risk factors for CVD. However, ways in which the program could be improved for future testing and dissemination were identified and discussed.
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Affiliation(s)
- Louise Thornton
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia
| | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, University of Newcastle, Callaghan, Australia
| | - Bree Tebbutt
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - Tanya L Hanstock
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Clark V, Conrad AM, Lewin TJ, Baker AL, Halpin SA, Sly KA, Todd J. Addiction Vulnerability: Exploring Relationships Among Cigarette Smoking, Substance Misuse, and Early Psychosis. J Dual Diagn 2018; 14:78-88. [PMID: 29261427 DOI: 10.1080/15504263.2017.1416436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Smoking rates in adolescents at risk for psychosis are significantly greater than in those who are not at risk. Recent research suggests that cigarette smoking in adolescence may be a potential marker of transition to psychosis, although the exact relationship between the two remains unclear. Our aim was to examine whether tobacco smoking is a potential marker of transition to psychosis or subsequent episodes of psychosis, independently of other substance use, or alternatively whether smoking is essentially a general marker of later mental illness episodes. METHODS This substudy was conducted as part of an audit of a specialized early psychosis community mental health service, the Psychological Assistance Service (PAS). A multilayered audit over 10 years (January 1997 to December 2007) of PAS presentations was conducted (N = 1997), which documented baseline sociodemographic and clinical characteristics and subsequent illness episodes and service usage. Among clients with baseline smoking status information (n = 421, mean age = 18.3 years), this study examined predictors of transition to or subsequent episodes of psychosis, substance misuse, and affective disorder. RESULTS A recent psychosis episode at baseline and receiving ongoing treatment from PAS predicted transition to or subsequent psychosis episodes; however, baseline ultra-high-risk status was not predictive. In addition, baseline smoking/substance misuse status was a significant predictor, with smokers being twice as likely to experience a subsequent episode of psychosis, even after controlling for other baseline comorbidity. Baseline smoking status also independently predicted subsequent substance misuse episodes, but not subsequent affective disorder. Among clients experiencing post-PAS comorbid substance misuse and psychosis, the majority (80.3%) reported smoking at baseline. CONCLUSIONS Smoking status at service presentation appeared to function as a general proxy for addiction vulnerability among young help seekers and thereby as a potential marker for the development of severe mental illness (including psychosis) and associated health problems. Routine evaluations of presenting problems need to incorporate comprehensive assessments of early substance misuse and tobacco smoking. Adjunctive lifestyle interventions promoting smoking cessation, physical health, and well-being need to be offered in conjunction with conventional mental health interventions tailored to key presenting problems, recovery, and psychological strengthening.
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Affiliation(s)
- Vanessa Clark
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Agatha M Conrad
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia.,b Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Terry J Lewin
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia.,b Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Amanda L Baker
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Sean A Halpin
- c School of Psychology, University of Newcastle , Callaghan , New South Wales , Australia
| | - Ketrina A Sly
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia.,b Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Juanita Todd
- c School of Psychology, University of Newcastle , Callaghan , New South Wales , Australia
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Baker AL, Richmond R, Kay-Lambkin FJ, Filia SL, Castle D, Williams JM, Lewin TJ, Clark V, Callister R, Palazzi K. Randomised controlled trial of a healthy lifestyle intervention among smokers with psychotic disorders: Outcomes to 36 months. Aust N Z J Psychiatry 2018; 52:239-252. [PMID: 28610482 DOI: 10.1177/0004867417714336] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE People living with psychotic disorders (schizophrenia spectrum and bipolar disorders) have high rates of cardiovascular disease risk behaviours, including smoking, physical inactivity and poor diet. We report cardiovascular disease risk, smoking cessation and other risk behaviour outcomes over 36 months following recruitment into a two-arm randomised controlled trial among smokers with psychotic disorders. METHODS Participants ( N = 235) drawn from three sites were randomised to receive nicotine replacement therapy plus (1) a Healthy Lifestyles intervention delivered over approximately 9 months or (2) a largely telephone-delivered intervention (designed to control for nicotine replacement therapy provision, session frequency and other monitoring). The primary outcome variables were 10-year cardiovascular disease risk and smoking status, while the secondary outcomes included weekly physical activity, unhealthy eating, waist circumference, psychiatric symptomatology, depression and global functioning. RESULTS Significant reductions in cardiovascular disease risk and smoking were detected across the 36-month follow-up period in both intervention conditions, with no significant differences between conditions. One-quarter (25.5%) of participants reported reducing cigarettes per day by 50% or more at multiple post-treatment assessments; however, few (8.9%) managed to sustain this across the majority of time points. Changes in other health behaviours or lifestyle factors were modest; however, significant improvements in depression and global functioning were detected over time in both conditions. Participants experiencing worse 'social discomfort' at baseline (e.g. anxiety, mania, poor self-esteem and social disability) had on average significantly worse global functioning, lower scores on the 12-Item Short Form Health Survey physical scale and significantly greater waist circumference. CONCLUSION Although the telephone-delivered intervention was designed as a comparison condition, it achieved excellent retention and comparable outcomes. Telephone-delivered smoking cessation support may potentially help to reduce smoking rates among people with psychotic disorders. Discomfort in social situations may also be a useful target for future health interventions, addressing confidence and social skills, and promoting social networks that reduce inactivity.
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Affiliation(s)
- Amanda L Baker
- 1 School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Robyn Richmond
- 2 School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Frances J Kay-Lambkin
- 1 School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,3 Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia.,4 National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Sacha L Filia
- 5 Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University, The Alfred Hospital, Melbourne, VIC, Australia
| | - David Castle
- 6 University of Melbourne, Melbourne, VIC, Australia.,7 Department of Psychiatry, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Jill M Williams
- 8 Division of Addiction Psychiatry, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Terry J Lewin
- 1 School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,3 Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia.,9 Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Vanessa Clark
- 3 Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia
| | - Robin Callister
- 10 Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - Kerrin Palazzi
- 11 Clinical Research Design, IT and Statistical Support Unit, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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Bonfioli E, Mazzi MA, Berti L, Burti L. Physical health promotion in patients with functional psychoses receiving community psychiatric services: Results of the PHYSICO-DSM-VR study. Schizophr Res 2018; 193:406-411. [PMID: 28709772 DOI: 10.1016/j.schres.2017.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/30/2017] [Accepted: 06/10/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Psychotic patients have poorer health behaviours, including poor diets and sedentary lifestyles increasing their risk for obesity, diabetes, hypertension, and dyslipidaemia, and tend to have a shorter life expectancy as compared to nonpsychiatric populations. Lifestyle intervention programmes that target modifiable risk factors in such patients have produced uneven results. The objective was to evaluate the efficacy of a package of health promotion strategies to improve diet and physical exercise in psychotic patients. Our hypothesis was that a pre- to post-treatment improvement in physical activity and dietary habits would occur in the group receiving intervention. METHOD This randomised controlled trial was carried out in four psychiatric services. The intervention included psychoeducation sessions on diet and physical activity and regular participation in walking groups (experimental group). The control group received routine treatment. The primary outcome was an improvement of at least one World Health Organization recommendation on diet and exercise. RESULTS Of a total of 326 subjects recruited, 169 were randomly assigned to the experimental group and 157 to the control group. An improvement in one or more World Health Organization criteria over baseline was observed in 25.4% of experimental group subjects and in 12.2% of control group subjects (odds ratio 2.46, 95% confidence interval 1.22-4.97; p=0.01). CONCLUSIONS A statistically significant proportion of the sample achieved post-treatment improvement in lifestyle habits, especially as regarded increased physical activity. A post-intervention reduction in lifestyle variability was also noted. Interventions directly addressing dietary habits may be desirable in psychotic patients.
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Affiliation(s)
- Elena Bonfioli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - Maria Angela Mazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - Loretta Berti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - Lorenzo Burti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, Daeppen JB, Saunders JB, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018; 2:CD004148. [PMID: 29476653 PMCID: PMC6491186 DOI: 10.1002/14651858.cd004148.pub4] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007. OBJECTIVES To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption. MAIN RESULTS We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment. AUTHORS' CONCLUSIONS We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.
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Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona Campbell
- The University of SheffieldSchool of Health and Related ResearchRegent StreetSheffieldUKS1 4DA
| | - Elizabeth D Pienaar
- South African Medical Research CouncilCochrane South AfricaPO Box 19070TygerbergCape TownSouth Africa7505
| | - Nicolas Bertholet
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - Jean B Daeppen
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - John B Saunders
- Royal Brisbane and Women's HospitalDepartment of PsychiatryCentre for Drug & Alcohol StudiesSchool of MedicineUniversity of Queensland/Royal Brisbane HospitalQueenslandAustralia4029
| | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneVaudSwitzerlandCH‐1010
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Adapting, Pilot Testing and Evaluating the Kick.it App to Support Smoking Cessation for Smokers with Severe Mental Illness: A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020254. [PMID: 30720772 PMCID: PMC5858323 DOI: 10.3390/ijerph15020254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/27/2018] [Accepted: 01/30/2018] [Indexed: 12/28/2022]
Abstract
(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking cessation intervention to assist relapse prevention and encourage sustained smoking cessation for young adults (aged 18⁻29 years) with SMI. (2) Methods: Using co-design principles, the researchers will adapt the Kick.it smartphone App in collaboration with a small sample of current and ex-smokers with SMI. In-depth interviews with smokers with SMI who have attempted to quit in the past 12 months and ex-smokers (i.e., those having not smoked in the past seven days) will explore their perceptions of smoking cessation support options that have been of value to them. Focus group participants will then give their feedback on the existing Kick.it App and any adaptations needed. The adapted App will then be pilot-tested with a small sample of young adult smokers with SMI interested in attempting to cut down or quit smoking, measuring utility, feasibility, acceptability, and preliminary outcomes in supporting their quit efforts. (3) Conclusions: This pilot work will inform a larger definitive trial. Dependent on recruitment success, the project may extend to also include smokers with SMI who are aged 30 years or more.
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Pilot Study of an Exercise Intervention for Depressive Symptoms and Associated Cognitive-Behavioral Factors in Young Adults With Major Depression. J Nerv Ment Dis 2017; 205:647-655. [PMID: 27805982 DOI: 10.1097/nmd.0000000000000611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study assesses the feasibility of integrating motivational interviewing (MI) with an exercise intervention. It also explores patterns of depressive symptom changes (cognitive, affective, and somatic subscales) and their relationship to cognitive, behavioral, and immunological factors (interleukin 6, IL-6, a marker for inflammation) across the exercise intervention. Twelve young adults (20.8 ± 1.7 years) meeting DSM-IV criteria for major depressive disorder received a brief MI intervention followed by a 12-week exercise intervention. Assessments were conducted preintervention, postintervention, throughout the intervention, and at follow-up. Preliminary results show differential effects of exercise, with the largest standardized mean improvements for the affective subscale (-1.71), followed by cognitive (-1.56) and somatic (-1.39) subscales. A significant relationship was observed between increased behavioral activation and lower levels of IL-6. Despite study limitations, the magnitude of changes suggests that natural remission of depressive symptoms is an unlikely explanation for the findings. A randomized controlled trial has commenced to evaluate effectiveness of the intervention.
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Gordon JS, Armin J, D Hingle M, Giacobbi P, Cunningham JK, Johnson T, Abbate K, Howe CL, Roe DJ. Development and evaluation of the See Me Smoke-Free multi-behavioral mHealth app for women smokers. Transl Behav Med 2017; 7:172-184. [PMID: 28155107 PMCID: PMC5526811 DOI: 10.1007/s13142-017-0463-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Women face particular challenges when quitting smoking, especially those with weight concerns. A multi-behavioral smoking cessation intervention addressing these concerns and incorporating guided imagery may assist women to engage in healthy lifestyle behaviors. An mHealth app can easily disseminate such an intervention. The goals of this pilot study were to develop and test the feasibility and potential of the See Me Smoke-Free™ mHealth app to address smoking, diet, and physical activity among women smokers. We used pragmatic, direct-to-consumer methods to develop and test program content, functionality, and the user interface and conduct a pre-/post-test, 90-day pilot study. We enrolled 151 participants. Attrition was 52%, leaving 73 participants. At 90 days, 47% of participants reported 7-day abstinence and significant increases in physical activity and fruit consumption. Recruitment methods worked well, but similar to other mHealth studies, we experienced high attrition. This study suggests that a guided imagery mHealth app has the potential to address multiple behaviors. Future research should consider different methods to improve retention and assess efficacy.
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Affiliation(s)
- Judith S Gordon
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Julie Armin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, USA
| | - Peter Giacobbi
- College of Physical Activity and Sports Sciences, University of West Virginia, Morgantown, WV, USA
| | - James K Cunningham
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Thienne Johnson
- Departments of Computer Science and Electrical and Computer Engineering, University of Arizona, Tucson, AZ, USA
| | | | - Carol L Howe
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Denise J Roe
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Early Therapeutic Alliance, Treatment Retention, and 12-Month Outcomes in a Healthy Lifestyles Intervention for People with Psychotic Disorders. J Nerv Ment Dis 2016; 204:894-902. [PMID: 27575791 DOI: 10.1097/nmd.0000000000000585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Engaging and retaining individuals with psychotic disorders in psychosocial treatments is difficult. Early therapeutic alliance, treatment retention, and 12-month outcomes were examined in a subsample of smokers with a psychotic disorder (N = 178) participating in a healthy lifestyles study comparing a telephone versus face-to-face delivered intervention. Therapeutic alliance was assessed using the Agnew Relationship Measure; primary outcomes were treatment retention and changes in symptoms and health behaviors. Contrary to expectations, early alliance did not predict treatment retention. However, elements of both client- and therapist-rated alliance predicted some clinical outcomes (e.g., higher confidence in the therapeutic alliance at session 1 predicted improvements in 12-month depression). Some modest interactions between early alliance and intervention condition were also identified (e.g., clients initially with lower self-perceived initiative, or higher therapist-perceived bonding benefited preferentially from the telephone-delivered intervention), highlighting the need to further examine the interplay between therapeutic alliance and treatment modality.
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Stubbs B, Firth J, Berry A, Schuch FB, Rosenbaum S, Gaughran F, Veronesse N, Williams J, Craig T, Yung AR, Vancampfort D. How much physical activity do people with schizophrenia engage in? A systematic review, comparative meta-analysis and meta-regression. Schizophr Res 2016; 176:431-440. [PMID: 27261419 DOI: 10.1016/j.schres.2016.05.017] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/15/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Physical activity (PA) improves health outcomes in people with schizophrenia. It is unclear how much PA people with schizophrenia undertake and what influences PA participation. We conducted a meta-analysis to investigate PA levels and predictors in people with schizophrenia. METHOD Major databases were searched from inception till 02/2016 for articles measuring PA (self-report questionnaire (SRQ) or objective measure (e.g. accelerometer)) in people with schizophrenia, including first episode psychosis (FEP). A random effects meta-analysis and meta-regression analysis were conducted. RESULTS 35 studies representing 3453 individuals with schizophrenia (40.0years; 64.0% male) were included. Engagement in light PA was 80.44min (95% CI 68.32-92.52, n=2658), 47.1min moderate-vigorous PA (95% CI 31.5-62.8, n=559) and 1.05min (95% CI 0.48-1.62, n=2533) vigorous PA per day. People with schizophrenia engaged in significantly less moderate (hedges g=-0.45, 95% CI -0.79 to -0.1, p=0.01) and vigorous PA (g=-0.4, 95% CI -0.60 to -0.18) versus controls. Higher light to moderate, but lower vigorous PA levels were observed in outpatients and in studies utilizing objective measures versus SRQ. 56.6% (95% CI 45.8-66.8, studies=12) met the recommended 150min of moderate physical activity per week. Depressive symptoms and older age were associated with less vigorous PA in meta-regression analyses. CONCLUSIONS Our data confirm that people with schizophrenia engage in significantly less moderate and vigorous PA versus controls. Interventions aiming to increase PA, regardless of intensity are indicated for people with schizophrenia, while specifically increasing moderate-vigorous PA should be a priority given the established health benefits.
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Affiliation(s)
- Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom.
| | - Joseph Firth
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Alexandra Berry
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Felipe B Schuch
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós Graduação em Ciências Médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Simon Rosenbaum
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Fiona Gaughran
- The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Nicola Veronesse
- Department of Medicine, Geriatrics Section, University of Padova, Italy
| | - Julie Williams
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom
| | - Tom Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
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A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with first-episode psychosis. Br J Nutr 2016; 115:1987-93. [DOI: 10.1017/s0007114516001033] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractSevere mental illness is characterised by a 20-year mortality gap due to cardiometabolic disease. Poor diet in those with severe mental illness is an important and modifiable risk factor. The present study aimed to (i) examine baseline nutritional intake in youth with first-episode psychosis (FEP), (ii) evaluate the feasibility and acceptability of nutritional intervention early in FEP and (iii) to evaluate the effectiveness of early dietary intervention on key nutritional end points. Participants were recruited over a 12-month period from a community-based programme specifically targeting young people aged 15–25 years with newly diagnosed FEP. Individual dietetic consultations and practical group sessions were offered as part of a broader lifestyle programme. Dietary assessments were conducted before and at the end of the 12-week intervention. Participants exceeded recommended energy and Na intakes at baseline. Retention within the nutrition intervention was 67 %, consistent with other interventions offered to FEP clients. There was a 47 % reduction in discretionary food intake (−94 g/d,P<0·001) and reductions in daily energy (−24 %,P<0·001) and Na (−26 %,P<0·001) intakes. Diet quality significantly improved, and the mean change was 3·6 (95 % CI 0·2, 6·9,P<0·05), although this finding was not significant after Bonferroni’s correction. Increased vegetable intake was the main factor contributing to improved diet quality. Nutrition intervention delivered shortly after initiation of antipsychotic medication is feasible, acceptable and effective in youth with FEP. Strategies to prevent weight gain and metabolic decline will contribute to prevent premature cardiometabolic disease in this vulnerable population.
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Tran TV, Canfield J, Wang K. Health behaviors and demographic factors of chronic health conditions among elderly veteran men. SOCIAL WORK IN HEALTH CARE 2016; 55:328-345. [PMID: 27123687 DOI: 10.1080/00981389.2015.1137255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As male veterans age, there are unique opportunities for health-related prevention efforts to be introduced throughout the life cycle to ameliorate the effects of chronic health conditions such as cardiovascular disease, asthma, arthritis, and diabetes. This study analyzed data from the Behavioral Risk Factor Surveillance System (2012) with a sample of 27,187 male veterans aged 65-84 years and 4,079 male veterans over 85 years of age. The study examined associations between behaviors, demographics, and five chronic health conditions with variables that included marital status, health insurance coverage, alcohol consumption, smoking history, and income levels. These associations varied between the two age groups, suggesting the need for intervention with veterans across their lifespans. Public health social workers could help veterans modify their health behaviors to prevent the occurrence or worsening of chronic health conditions over time and across the aging process.
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Affiliation(s)
- Thanh V Tran
- a School of Social Work , Boston College , Chestnut Hill , Massachusetts , USA
| | - Julie Canfield
- a School of Social Work , Boston College , Chestnut Hill , Massachusetts , USA
| | - Kaipeng Wang
- a School of Social Work , Boston College , Chestnut Hill , Massachusetts , USA
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Stubbs B, Williams J, Gaughran F, Craig T. How sedentary are people with psychosis? A systematic review and meta-analysis. Schizophr Res 2016; 171:103-9. [PMID: 26805414 DOI: 10.1016/j.schres.2016.01.034] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/05/2016] [Accepted: 01/15/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Sedentary behavior (SB) is an independent risk factor for cardiovascular disease and mortality. We conducted a meta-analysis to investigate SB levels and predictors in people with psychosis. METHOD Major electronic databases were searched from inception till 09/2015 for articles measuring SB with a self-report questionnaire (SRQ) or objective measure (e.g. accelerometer) in people with psychosis, including schizophrenia spectrum and bipolar disorders. A random effects meta-analysis and meta regression analysis were conducted. RESULTS Thirteen studies were eligible including 2033 people with psychosis (mean age 41.3years (range 25.1-60), 63.2% male (range 35-89%), body mass index 28.7 (range 25.9-32.1). The trim and fill analysis demonstrated people with psychosis spent 660.8min (95% CI 523.2-798.4, participants=2033) or 11.0h (95% CI 8.72-13.3) per day being sedentary. Objective measures of SB recorded significantly higher levels (p<0.001) of SB (12.6h per day, 95% CI 8.97-16.2, studies=7, participants=254) compared to self-report SB (6.85h per day, 95% CI 4.75-8.96, studies=6, participants=1779). People with psychosis engaged in significantly more SB than controls (g=1.13, 95% CI 0.496-1.77, P<0.001, n psychosis=216, n controls=159) equating to a mean difference of 2.80 (95% CI 1.47-4.1) hours per day. Multivariate meta-regression confirmed that objective measurement of SB predicted higher levels of sedentariness. CONCLUSIONS People with psychosis engage in very high levels of sedentary behavior in their waking day and current SRQ may underestimate SB. Given that SB is an independent predictor of cardiovascular disease, future interventions specifically targeting the prevention of SB are warranted.
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Affiliation(s)
- Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom.
| | - Julie Williams
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom
| | - Fiona Gaughran
- The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Tom Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom
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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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Baker AL, Richmond R, Kay-Lambkin FJ, Filia SL, Castle D, Williams JM, Lewin TJ, Clark V, Callister R, Weaver N. Randomized Controlled Trial of a Healthy Lifestyle Intervention Among Smokers With Psychotic Disorders. Nicotine Tob Res 2015; 17:946-54. [DOI: 10.1093/ntr/ntv039] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 02/12/2015] [Indexed: 12/22/2022]
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