Cigarette Smoking and Health Characteristics in Individuals With Serious Mental Illness Enrolled in a Behavioral Weight Loss Trial

Gender Differences in the Interrelations Among Social Support, Stressful Life Events, and Smoking Cessation in People With Severe Mental Illnesses

BACKGROUND

Social support and stressful life events (SLEs) have been found to be influential factors for smoking cessation in the general population, but little is known about these factors among smokers with severe mental illnesses (SMIs) and whether their associations with smoking cessation differ by gender.

AIMS

To examine the association between social support and smoking cessation as mediated by SLEs in people with SMI and to examine whether the interrelations among social support, SLEs, and smoking cessation differ by gender.

METHODS

A population sample of 4,610 American lifetime adult smokers with schizophrenia, bipolar disorder, or major depressive disorder were identified in a limited public use data set of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Four mediation and moderated mediation models were used to examine gender differences in the interrelations among social support (total and three subscales of the Interpersonal Support Evaluation List-12), SLEs (summative score of positive responses to 16 types experienced in past year and related to health, job, death, or legal situations), and smoking status in prior year.

RESULTS

Total, appraisal, and tangible support among females exerted indirect effects on smoking cessation via decreasing SLE scores. Among males, only belonging support exerted an indirect effect on smoking cessation via an increased SLE score.

CONCLUSIONS

Findings suggest that interventions focusing on improving social support should be a priority for those working with smokers with SMI.

Weight Reduction Goal Achievement Among Veterans With Mental Health Diagnoses

BACKGROUND: Despite the use of weight management programs among veterans, the impact of mental health diagnoses on weight reduction goal achievement is unknown. AIMS: We aimed to describe the prevalence and association of mental health diagnoses with a 5% weight reduction goal achievement. METHODS: Logistic regression was used to describe the association between mental health diagnoses and weight reduction goal achievement at 6, 12, and 24 months among 402 veterans enrolled in a weight management program. RESULTS: More than 43% of veterans had a mental health diagnoses, with depressive disorders, posttraumatic stress disorder (PTSD), and substance use disorders being the most prevalent. At all three times, simply having a mental health diagnosis was not associated with weight reduction goal achievement. Specific diagnoses were associated with a greater likelihood of achieving weight reduction goals at 12 months (PTSD and Drug Use Disorder) and 24 months (Anxiety Disorder and Other Mental Health Diagnosis). CONCLUSION: The findings suggest that unhealthy weight is quite common for individuals with mental health diagnoses; however, weight reduction goal achievement may be equally likely for those with and without mental health diagnoses. The prevalence of mental health diagnoses among veterans seeking weight reduction suggests that psychiatric nurses should be aware of this common comorbidity.

Predictors of smoking cessation group treatment engagement among veterans with serious mental illness

High prevalence rates of tobacco use, particularly cigarettes, pose a serious health threat for individuals with serious mental illness (SMI), and research has demonstrated the effectiveness of pharmacotherapy and psychosocial interventions to reduce tobacco use in this group. However, few studies have considered predictors of tobacco cessation treatment engagement among individuals with SMI. The current study examined predictors of engagement in smoking cessation groups among veterans with SMI engaged in mental health services at three VA medical centers. All veterans were participating in a smoking cessation treatment study. Of 178 veterans who completed baseline assessments, 127 (83.6%) engaged in treatment, defined as attending at least three group sessions. Forty-one (N=41) predictors across five domains (demographics, psychiatric concerns, medical concerns, smoking history, and self-efficacy to quit smoking) were identified based on previous research and clinical expertise. Using backward elimination to determine a final multivariable logistic regression model, three predictors were found to be significantly related to treatment engagement: marital status (never-married individuals more likely to engage); previous engagement in group smoking cessation services; and greater severity of positive symptoms on the Brief Psychiatric Rating Scale. When included in the multivariable logistic regression model, the full model discriminates between engagers and non-engagers reasonably well (c statistic=0.73). Major considerations based on these findings are: individuals with SMI appear to be interested in smoking cessation services; and serious psychiatric symptomatology should not discourage treatment providers from encouraging engagement in smoking cessation services.

Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis

BACKGROUND

Cardiovascular risk (CVR) has been observed to be higher in patients with severe mental illness (SMI) than in the general population. However, some studies suggest that CVR is not equally increased in different subgroups of SMI. The purposes of this review are to summarise CVR scores of SMI patients and to determine the differences in CVR between patients with different SMIs and between SMI patients and the control-population.

METHODS

MEDLINE (via PubMed) was searched for literature published through August 28, 2014, followed by a snowball search in the Web of Science. Observational and experimental studies that reported CVR assessments in SMI patients using validated tools were included. The risk of bias was reported using STROBE and CONSORT criteria. Pooled continuous data were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). Two reviewers independently selected studies, extracted data and assessed methodological quality.

RESULTS

A total of 3,608 articles were identified, of which 67 full text papers were assessed for eligibility and 35 were finally included in our review, in which 12,179 psychiatric patients and 225,951 comparative patients had been assessed. The most frequent diagnoses were schizophrenia and related diagnoses (45.7%), depressive disorders (14.7%), SMI (11.4%) and bipolar disorders (8.6%). The most frequent CVR assessment tool used was the Framingham risk score. Subgroups analysis showed a higher CVR in schizophrenia than in depressive disorder or in studies that included patients with multiple psychiatric diagnoses (SMD: 0.63, 0.03, and 0.02, respectively). Six studies were included in the meta-analysis. Total overall CVR did not differ between SMI patients and controls (SMD: 0.35 [95% CI:-0.02 to 0.71], p = 0.06); high heterogeneity was observed (I (2) = 93%; p < 0.001).

CONCLUSIONS

The summary of results from studies that assessed CVR using validated tools in SMI patients did not find sufficient data (except for limited evidence associated with schizophrenia) to permit any clear conclusions about increased CVR in this group of patients compared to the general population. The systematic review is registered in

PROSPERO

CRD42013003898 .

Improving lifestyle interventions for people with serious mental illnesses: Qualitative results from the STRIDE study

OBJECTIVE

Individuals with serious mental illnesses are disproportionately affected by overweight and obesity. Understanding the factors that facilitate or hinder lifestyle change in this population could lead to better interventions and improved health outcomes.

METHODS

A subset of intervention and usual-care participants (n = 84) in the STRIDE randomized trial were interviewed at 3, 9, and 18 months, yielding 101 interviews (some were interviewed more than once). Participants had a mean age of 48.1 (SD = 10.1); 64% were female. Participants had diagnoses of schizophrenia or schizoaffective disorder (41%), bipolar disorder (20%), affective psychoses (37%), or PTSD (2%). Interviews were transcribed verbatim, coded using Atlas.ti, and analyzed for common themes.

RESULTS

Barriers to behavior change were similar to those described for the general population, including lack of support from significant others, the lure of unhealthy foods, and poor weather impeding exercise. Additional challenges included the effects of psychiatric symptoms, or consequences of symptoms (i.e., social isolation), on ability to make and sustain lifestyle changes. We found a strong preference for ongoing, group-based support to foster a sense of accountability which motivated and helped to sustain behavior changes.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Individuals with serious mental illnesses encounter many of the same barriers to weight loss seen in the general population, but they may be more vulnerable to additional obstacles. Lifestyle change interventions for this population should help participants develop the ability to iteratively cope with fluctuating mood and subsequent changes in motivation to eat healthfully and exercise regularly.

Cigarette smoking and interest in quitting among overweight and obese adults with serious mental illness enrolled in a fitness intervention

This study explored cigarette smoking, health status, and interest in quitting among overweight and obese adults with serious mental illness enrolled in a fitness intervention. Baseline data from two studies of the In SHAPE fitness intervention were combined. A total of 341 overweight or obese adults with serious mental illness were assessed on smoking, interest in quitting, cardiovascular fitness, lipids, body mass index, readiness to change diet, and psychiatric symptoms. Thirty-six percent (n = 122) of participants were categorized as current smokers. The majority of smokers (84%) were interested in quitting. Smokers were more likely to be younger, male, and less educated than non-smokers. Smokers had lower high-density lipoprotein cholesterol and were less ready to reduce dietary fat, after adjusting for age, gender, and education. Findings highlight the potential to address both fitness and smoking to reduce cardiovascular risk in individuals with serious mental illness.

Social predictors of cessation treatment use among smokers with serious mental illness

OBJECTIVE

Social factors play an important role in quitting smoking in the general population, but relatively little is known about social influences on smoking cessation efforts among individuals with serious mental illness who suffer disproportionately high rates of smoking. This study examined social factors as predictors of using smoking cessation treatment among adults with serious mental illness.

METHODS

We conducted a secondary analysis of data from a randomized study comparing two versions of a motivational decision support system for smoking cessation treatment including 124 smokers with schizophrenia or severe mood disorders. Hierarchical logistic regression with blocked entry of theoretically linked predictor variables was used to model two types of social influences (explicit and implicit) as predictors of using cessation group therapy or smoking cessation medication.

RESULTS

Approximately 31% of participants initiated smoking cessation treatment during the 2-month follow-up. Hierarchical logistic regression analyses revealed that over and above demographic and personal factors, implicit social influences (others' approval of treatment) significantly predicted use of smoking cessation medication, while explicit social influences (smoking with others) significantly predicted use of cessation group therapy.

CONCLUSIONS

For people with serious mental illness, social factors appear to influence use of smoking cessation treatment above and beyond personal factors and may be specific to the type of treatment. These data support the need to further explore the role of social factors as potential leverage points for engagement in smoking cessation treatments in this population.

Mortality in schizophrenia: clinical and serological predictors

Persons with schizophrenia have a reduced life expectancy largely due to death from natural causes. Factors that have been previously associated with excess mortality include cigarette smoking and antipsychotic medication. The role of other environmental factors such as exposure to infectious agents has been the subject of only limited investigation. We prospectively assessed a cohort of persons with schizophrenia with a clinical evaluation and a blood sample from which antibodies to human herpes viruses and Toxoplasma gondii were measured. Mortality was determined with data from the National Death Index following a period of up to 11 years. We examined the role of demographic, serological, and clinical factors on mortality. A total of 25 (5%) of 517 persons died of natural causes. The standardized mortality ratio was 2.80 (95% CI 0.89, 6.38). After adjusting for age and gender, mortality from natural causes was predicted in separate models by cigarette smoking (relative risk [RR] = 4.66, P = .0029); lower cognitive score (RR = 0.96, P = .013); level of antibodies to Epstein-Barr virus (RR = 1.22, P = .0041) and to Herpes Simplex virus type 1 (RR = 1.19, P = .030); immunologic disease (RR = 3.14, P = .044); and genitourinary disease (RR = 2.70; P = .035). Because cigarette smoking confers an almost 5-fold risk of mortality, smoking cessation is an urgent priority. Having an elevated level of antibodies to Epstein-Barr virus and to Herpes Simplex virus type 1 are also significant predictors of death from natural causes.