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Bartels S, Levison JH, Trieu HD, Wilson A, Krane D, Cheng D, Xie H, Donelan K, Bird B, Shellenberger K, Cella E, Oreskovic NM, Irwin K, Aschbrenner K, Fathi A, Gamse S, Holland S, Wolfe J, Chau C, Adejinmi A, Langlois J, Reichman JL, Iezzoni LI, Skotko BG. Tailored vs. General COVID-19 prevention for adults with mental disabilities residing in group homes: a randomized controlled effectiveness-implementation trial. BMC Public Health 2024; 24:1705. [PMID: 38926810 PMCID: PMC11201789 DOI: 10.1186/s12889-024-18835-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA). METHODS A hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (Tailored Best Practices: TBP) to dissemination of standard prevention guidelines (General Best-Practices: GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including: (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline: 1/1/2021-3/31/2021) and fidelity scores (baseline: 5/1/21-7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline: 1/1/2021-3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections. RESULTS GHs (n=415) were randomized to TBP (n=208) and GBP (n=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White: 2.28, p = 0.03). CONCLUSION Tailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities. TRIAL REGISTRATION ClinicalTrials.gov, NCT04726371, 27/01/2021. https://clinicaltrials.gov/study/NCT04726371 .
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Affiliation(s)
- Stephen Bartels
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA.
| | - Julie H Levison
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA
| | - Hao D Trieu
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Anna Wilson
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - David Krane
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - David Cheng
- Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA
| | - Haiyi Xie
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Third Floor, HB 7261, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Karen Donelan
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Bruce Bird
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | | | - Elizabeth Cella
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Nicolas M Oreskovic
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Gray 7-730, Boston, MA, 02114, USA
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02214, USA
| | - Kelly Irwin
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kelly Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Ahmed Fathi
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Stefanie Gamse
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Sibyl Holland
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Jessica Wolfe
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Cindy Chau
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Adeola Adejinmi
- Bay Cove Human Services, 66 Canal Street, Boston, MA, 02114, USA
| | | | | | - Lisa I Iezzoni
- Mongan Institute, Massachusetts General Hospital,, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02214, USA
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Browne J, Naslund JA, Salwen-Deremer JK, Sarcione C, Cabassa LJ, Aschbrenner KA. Factors influencing engagement in in-person and remotely delivered lifestyle interventions for young adults with serious mental illness: A qualitative study. Early Interv Psychiatry 2024; 18:42-48. [PMID: 37220910 PMCID: PMC10665543 DOI: 10.1111/eip.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/20/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023]
Abstract
AIM Young adults (ages 18-35) are underrepresented in lifestyle interventions for people with serious mental illness (SMI), such as schizophrenia, bipolar disorder, and severe depression, and little is known about factors influencing their engagement in these programmes. This qualitative study examined factors affecting engagement amongst young adults with SMI who were enrolled in a lifestyle intervention trial at community mental health centres. METHODS Seventeen young adults with SMI participated in this qualitative study. Participants were drawn from a 12-month randomized controlled trial (n = 150) comparing an in-person group lifestyle intervention augmented with mobile health technology (PeerFIT) to one-on-one personalized remote health coaching (BEAT) using purposive sampling. The 17 participants completed semi-structured qualitative interviews at post-intervention to explore their perceived benefits of the intervention and factors impacting engagement. We used a team-based descriptive qualitative approach to code transcripts and identify themes in the data. RESULTS Participants across both interventions reported experiencing improved ability to engage in health behaviour change. Participants described managing psychosocial stressors and family and other responsibilities that limited their ability to attend in-person PeerFIT sessions. The remote and flexible BEAT remote health coaching intervention appeared to facilitate engagement even in the context of challenging life circumstances. CONCLUSIONS Remotely delivered lifestyle interventions can facilitate engagement amongst young adults with SMI navigating social stressors.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Research Service, VA Providence Health Care System, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica K Salwen-Deremer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Carrie Sarcione
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Finucane FM, Gibson I, Hughes R, Murphy E, Hynes L, Harris A, McGuire BE, Hynes M, Collins C, Cradock K, Seery S, Jones J, O’Brien T, O’Donnell MJ. Factors associated with weight loss and health gains in a structured lifestyle modification programme for adults with severe obesity: a prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1257061. [PMID: 37916153 PMCID: PMC10616877 DOI: 10.3389/fendo.2023.1257061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
Background Individual responses to behavioural weight loss interventions can vary significantly, and a better understanding of the factors associated with successful treatment might help to target interventions for those who will benefit the most. We sought to identify demographic and clinical characteristics that predicted intervention "success" (defined as ≥5% weight loss) and other health gains in patients with severe obesity attending a ten-week structured lifestyle modification programme. Methods We conducted a prospective cohort study of all 1122 patients (751 (66.9%) female, mean age 47.3 ± 11.9 years, mean body mass index (BMI) 46.7 ± 7.8 kgm-2) referred from our hospital-based obesity clinic, who started the structured lifestyle programme between 2012-2019. We compared routine clinical measures such as weight, fitness, blood pressure, lipids and HbA1c at baseline and follow-up. We also used validated questionnaires to quantify anxiety, depression and health-related quality of life. Results Of 1122 patients who started, 877 (78.2%) completed the programme and attended for follow up. Of these, 12.8% lost ≥5% body weight. The amount of weight lost was a strong and consistent predictor of improvements in metabolic, cardiovascular, and mental health, even after adjusting for age, sex, programme attendance and baseline fitness. Older age, male sex, being physically active and having lower anxiety and depression scores at baseline predicted greater weight loss. Younger age, depression and longer wait time to start the intervention were associated with drop-out. Conclusions In adults with severe obesity completing a structured lifestyle modification programme, older age and good mental health were associated with programme completion and attaining ≥5% weight loss. The magnitude of weight lost was a strong predictor of improvements in cardiovascular, metabolic and mental health associated with programme completion.
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Affiliation(s)
- Francis M. Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
| | - Irene Gibson
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Robert Hughes
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Enda Murphy
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
| | - Lisa Hynes
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Aisling Harris
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Brian E. McGuire
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- School of Psychology, University of Galway, Galway, Ireland
| | - Mary Hynes
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- School of Psychology, University of Galway, Galway, Ireland
| | - Chris Collins
- Department of Upper Gastrointestinal Surgery, Galway University Hospital, Galway, Ireland
| | - Kevin Cradock
- Department of Health and Nutrition Sciences, Atlantic Technological University, Sligo, Ireland
| | - Suzanne Seery
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Jennifer Jones
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Tim O’Brien
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
| | - Martin J. O’Donnell
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
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Suen YN, Lee EHM, Lam COB, Hui CLM, Chan SKW, Chang WC, Chen EYH. Evaluating a pilot community-based FITMIND exercise programme for psychosis in Hong Kong. BMC Psychiatry 2023; 23:385. [PMID: 37259084 DOI: 10.1186/s12888-023-04901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Exercise interventions can improve clinical symptoms and cognition in patients with psychosis in addition to their physical health. However, their benefits may not be maximally generalised to those who cannot access gymnasium facilities, which were commonly required previously. This study evaluated a 12-week community exercise programme named FITMIND, which aims to help patients with psychosis establish exercise habits through easy-to-learn aerobic exercise and yoga, with the support of trained volunteers. METHOD This study analysed the profiles of 49 patients with psychosis who were referred by the case manager of the early psychosis programme in the public hospital in Hong Kong or enrolled in the programme through the project website. The outcome measures were working memory, physical activity (PA) participation, quality of life, and mood symptoms. RESULTS At baseline, seven participants (14.3%) met the recommendation of the PA for severe mental illnesses. After the 12-week programme, participants demonstrated significant improvement in vigorous-intensity PA, moderate-to-vigorous PA, compliance with international guidelines for PA, and mood symptoms. CONCLUSION The FITMIND exercise programme is a feasible community-based intervention that can improve PA participation and mood in patients with psychosis. Further systematic studies are needed to examine the long-term beneficial effects of the programme.
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Affiliation(s)
- Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Christina Oi Bun Lam
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.
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Healthy choices, healthy changes: A randomized trial of incentives to promote healthy eating and exercise in people with schizophrenia and other serious mental illnesses. Schizophr Res 2023; 255:1-8. [PMID: 36933290 DOI: 10.1016/j.schres.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 01/12/2023] [Accepted: 03/03/2023] [Indexed: 03/20/2023]
Abstract
INTRODUCTION People with schizophrenia and other serious mental illnesses (SMI) represent a concerning health disparity population, with 10-30 fewer years of life compared to the general population, mainly from high rates of cardiovascular disease (CVD). Preventing CVD is possible with exercise and diet interventions, but only 50 % of participants in clinical trials achieve reduction in CVD risk. This study assessed whether cash incentives improved weight loss, cardiovascular endurance, and/or mortality risk when added to one of four healthy lifestyle programs (gym membership, Weight Watchers membership, the InSHAPE program, InSHAPE + Weight Watchers). METHODS From 2012 to 2015, 1348 overweight or obese adults with SMI enrolled in a study using equipoise stratified randomization. Participants were randomly assigned to intervention, then to cash incentives, or not, for participation (gym and/or Weight Watchers), with baseline and quarterly assessments for 12 months. We examined effects of the interventions, key covariates, and incentives, using generalized linear models. RESULTS Main effects of randomization to receive cash incentives was not significant for any outcome; whereas total amount of incentives was significantly associated with all three primary outcomes (weight loss, cardiovascular endurance, mortality risk), mainly for participants in the InSHAPE+WW group who received additional cash incentives. CONCLUSIONS Incentives may be effective at preventing CVD and improving health outcomes for people with SMI, especially in the context of intensive support for healthy lifestyle behaviors. Policy changes are required to increase access to healthy lifestyle programming and more research is needed to establish the optimal amount of incentives for people with SMI. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02515981.
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Browne J, Battaglini C, Jarskog LF, Sheeran P, Abrantes AM, Elliott T, Gonzalez O, Penn DL. Virtual Group-based Walking Intervention for Persons with Schizophrenia: A Pilot Randomized Controlled Trial. Ment Health Phys Act 2023; 24:100515. [PMID: 37123563 PMCID: PMC10135421 DOI: 10.1016/j.mhpa.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Persons with schizophrenia have reduced cardiorespiratory fitness (CRF), a predictor of all-cause mortality. Exercise is effective for improving CRF; however, motivational challenges affecting those with schizophrenia impact exercise engagement and maintenance. Virtual Physical Activity Can Enhance Life (Virtual PACE-Life), a multicomponent walking intervention guided by self-determination theory (SDT), was developed to target CRF in this population while addressing motivational difficulties. Virtual PACE-Life includes live video-delivered group walking sessions, Fitbit activity tracking, recommendations for home-based walking sessions, goal setting, and if-then plans. The present study was a 16-week pilot randomized controlled trial that evaluated the impact of Virtual PACE-Life against Fitbit Alone in a sample of 37 participants with schizophrenia on intermediate targets (competence, autonomy, and relatedness satisfaction, autonomous motivation), proximal outcomes (Fitbit-measured steps/day and minutes spent walking), and the primary outcome (CRF using the 6-minute walk test). Blinded research staff completed assessments at baseline, midpoint, posttest, and one-month follow-up. Analysis of covariance and hierarchical linear regression analyses were used to evaluate group differences at each timepoint controlling for baseline. Attendance at Virtual PACE-Life groups was 58% and Fitbit adherence was above 70% in both conditions. Intent-to-treat results indicated greater competence and autonomy satisfaction for Virtual PACE-Life but not in relatedness satisfaction or autonomous motivation. There were no group differences in proximal or primary outcomes during the intervention period. Completer analyses showed improvements in steps/day and autonomous motivation favoring Virtual PACE-Life. Future research is needed to maximize the exercise and CRF benefits of virtual group-based exercise for persons with schizophrenia.
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Affiliation(s)
- Julia Browne
- Research Service, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Claudio Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L. Fredrik Jarskog
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Tonya Elliott
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Oscar Gonzalez
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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Best practices to reduce COVID-19 in group homes for individuals with serious mental illness and intellectual and developmental disabilities: Protocol for a hybrid type 1 effectiveness-implementation cluster randomized trial. Contemp Clin Trials 2023; 125:107053. [PMID: 36539061 PMCID: PMC9758744 DOI: 10.1016/j.cct.2022.107053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND People with serious mental illness (SMI) and intellectual disabilities and/or developmental disabilities (ID/DD) living in group homes (GHs) and residential staff are at higher risk for COVID-19 infection, hospitalization, and death compared with the general population. METHODS We describe a hybrid type 1 effectiveness-implementation cluster randomized trial to assess evidence-based infection prevention practices to prevent COVID-19 for residents with SMI or ID/DD and the staff in GHs. The trial will use a cluster randomized design in 400 state-funded GHs in Massachusetts for adults with SMI or ID/DD to compare effectiveness and implementation of "Tailored Best Practices" (TBP) consisting of evidence-based COVID-19 infection prevention practices adapted for residents with SMI and ID/DD and GH staff; to "General Best Practices" (GBP), consisting of required standard of care reflecting state and federal standard general guidelines for COVID-19 prevention in GHs. External (i.e., community-based research staff) and internal (i.e., GH staff leadership) personnel will facilitate implementation of TBP. The primary effectiveness outcome is incident SARS-CoV-2 infection and secondary effectiveness outcomes include COVID-19-related hospitalizations and mortality in GHs. The primary implementation outcomes are fidelity to TBP and rates of COVID-19 vaccination. Secondary implementation outcomes are adoption, adaptation, reach, and maintenance. Outcomes will be assessed at baseline, 3-, 6-, 9-, 12-, and 15-months post-randomization. CONCLUSIONS This study will advance knowledge on comparative effectiveness and implementation of two different strategies to prevent COVID-19-related infection, morbidity, and mortality and promote fidelity and adoption of these interventions in high-risk GHs for residents with SMI or ID/DD and staff. CLINICAL TRIAL REGISTRATION NUMBER NCT04726371.
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O'Neill K, Hand R, Diop B, Weiss H, Cruz Pfaeffle A, Maragatham P, Rice K, Naslund JA. Informing the development of the coaching online and community health (COACH) program: a qualitative study of clubhouse members living with serious mental illness. Transl Behav Med 2023; 13:343-353. [PMID: 36694908 DOI: 10.1093/tbm/ibad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Health and wellness interventions addressing risk factors for early mortality among individuals with serious mental illness have demonstrated success and can be further augmented with digital technology. These programs may be suitable for delivery in psychosocial rehabilitation clubhouses, especially given many services have transitioned to digital platforms during the pandemic. This qualitative study aimed to: (a) explore clubhouse members' experiences engaging with the virtual clubhouse platform, and their preferences for accessing digital wellness and health promotion content; and, (b) gauge members' interest in an online peer-driven lifestyle intervention and their suggestions for program design. This study was guided by a community-based participatory action research framework. Ten focus groups were conducted with clubhouse members. Focus groups were coded and analyzed thematically by trained clubhouse members and the research team. Thirty-three members participated in the focus groups. Participants expressed the importance of having technical support from staff; that one-on-one support and consistent communication are important to keep them engaged in health and wellness programming; and described mixed views about use of the virtual platform, but generally were open to engaging in lifestyle intervention programming virtually. Participants who joined the clubhouse during the pandemic expressed feeling overwhelmed by in-person gatherings, and were especially interested in opportunities for remote participation. This study can inform health and wellness programming for delivery on the virtual clubhouse platform for members. The taxonomy of codes, created to generate a framework with recommendations, will inform the design of a virtual health and wellness intervention.
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Affiliation(s)
- Kathryn O'Neill
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | | | | | | | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
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Godin O, Pignon B, Szoke A, Boyer L, Aouizerate B, Schorr B, André M, Capdevielle D, Chereau I, Coulon N, Dassing R, Dubertret C, Etain B, Leignier S, Llorca PM, Mallet J, Misdrahi D, Passerieux C, Rey R, Urbach M, Schürhoff F, Leboyer M, Fond G, Andre M, Andrieu-Haller C, Aouizerate B, Berna F, Blanc O, Bourguignon E, Capdevielle D, Chereau-Boudet I, Clauss-Kobayashi J, Coulon N, D'Amato T, Dassing R, Dorey JM, Dubertret C, Esselin A, Fond G, Gabayet F, Jarroir M, Lacelle D, Lançon C, Laouamri H, Leboyer M, Leignier S, Llorca, Mallet J, Metairie E, Michel T, Misdrahi D, Passerieux C, Petrucci J, Pignon B, Peri P, Portalier C, Rey R, Roman C, Schorr B, Schürhoff F, Szöke A, Tessier A, Urbach M, Wachiche G, Zinetti-Bertschy A. 3-year incidence and predictors of metabolic syndrome in schizophrenia in the national FACE-SZ cohort. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110641. [PMID: 36122839 DOI: 10.1016/j.pnpbp.2022.110641] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 12/01/2022]
Abstract
AIMS Metabolic Syndrome (MetS) is a major health epidemic of Western countries and patients with schizophrenia is a particularly vulnerable population due to lifestyle, mental illness and treatment factors. However, we lack prospective data to guide prevention. The aim of our study is then to determine MetS incidence and predictors in schizophrenia. METHOD Participants were recruited in 10 expert centers at a national level and followed-up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Inverse probability weighting methods were used to correct for attrition bias. RESULTS Among the 512 participants followed-up for 3 years, 77.9% had at least one metabolic disturbance. 27.5% were identified with MetS at baseline and excluded from the analyses. Among the rest of participants (N = 371, mean aged 31.2 (SD = 9.1) years, with mean illness duration of 10.0 (SD = 7.6) years and 273 (73.6%) men), MetS incidence was 20.8% at 3 years and raised to 23.6% in tobacco smokers, 29.4% in participants receiving antidepressant prescription at baseline and 42.0% for those with 2 disturbed metabolic disturbances at baseline. Our multivariate analyses confirmed tobacco smoking and antidepressant consumption as independent predictors of MetS onset (adjusted odds ratios (aOR) = 3.82 [1.27-11.45], p = 0.016, and aOR = 3.50 [1.26-9.70], p = 0.0158). Antidepressant prescription predicted more specifically increased lipid disturbances and paroxetine was associated with the highest risk of MetS onset. CONCLUSION These results are an alarm call to prioritize MetS prevention and research in schizophrenia. We have listed interventions that should be actively promoted in clinical practice.
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Affiliation(s)
- O Godin
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - B Pignon
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - A Szoke
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - L Boyer
- Fondation FondaMental, Créteil, France; AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux F-33076, France; INRAE, NutriNeuro, University of Bordeaux, U1286, Bordeaux F-33076, France
| | - B Schorr
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - M André
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - N Coulon
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - R Dassing
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - B Etain
- Fondation FondaMental, Créteil, France; Assistance Publique des Hopitaux de Paris (AP-HP), GHU Saint-Louis - Lariboisiere - Fernand Widal, DMU Neurosciences, Departement de Psychiatrie et de Medecine Addictologique, INSERM UMRS 1144, Universite de Paris, Paris, France
| | - S Leignier
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - J Mallet
- Fondation FondaMental, Créteil, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France; University of Bordeaux, CNRS UMR 5287-INCIA «Neuroimagerie et Cognition Humaine», France
| | - C Passerieux
- Fondation FondaMental, Créteil, France; Service Universitaire de psychiatrie et d'addictologie du Centre Hospitalier de Versailles, INSERM UMR1018, CESP, Team "DevPsy", Université de Versailles Saint-Quentin-en-Yvelines, Paris, Saclay, France
| | - R Rey
- Fondation FondaMental, Créteil, France; INSERM U1028 CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Service Universitaire de psychiatrie et d'addictologie du Centre Hospitalier de Versailles, INSERM UMR1018, CESP, Team "DevPsy", Université de Versailles Saint-Quentin-en-Yvelines, Paris, Saclay, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France; Université Paris-Est Créteil, INSERM U955, Département Hospitalo-Universitaire de Psychiatrie et d'Addictologie des Hôpitaux Universitaires H Mondor, AP-HP, Créteil, France
| | - G Fond
- Fondation FondaMental, Créteil, France; AP-HM, Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France.
| | | | - M Andre
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - C Andrieu-Haller
- Fondation Fondamental, France; AP-HM, La Conception Hospital, Aix-Marseille Univ., School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - B Aouizerate
- Fondation Fondamental, France; University Department of General Psychiatry), Charles Perrens Hospital, F-33076 Bordeaux, France; Laboratory of Nutrition and Integrative Neurobiology (UMR INRA 1286), University of Bordeaux, Bordeaux, France
| | - F Berna
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - O Blanc
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - E Bourguignon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - D Capdevielle
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - I Chereau-Boudet
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - J Clauss-Kobayashi
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - N Coulon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - T D'Amato
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - R Dassing
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - J M Dorey
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - C Dubertret
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - A Esselin
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - G Fond
- Fondation Fondamental, France; AP-HM, La Conception Hospital, Aix-Marseille Univ., School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - F Gabayet
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - M Jarroir
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - D Lacelle
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - C Lançon
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | | | - M Leboyer
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - S Leignier
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - Llorca
- Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue montalembert, Clermont-Ferrand Cedex 1, France
| | - J Mallet
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - E Metairie
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - T Michel
- Fondation Fondamental, France; University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061, Montpellier, France
| | - D Misdrahi
- Fondation Fondamental, France; University Department of General Psychiatry, Charles Perrens Hospital, F-33076, Bordeaux, France; CNRS UMR 5287-INCIA, Bordeaux, France
| | - C Passerieux
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - J Petrucci
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - B Pignon
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - P Peri
- Fondation Fondamental, France; Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - C Portalier
- Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Inserm UMR1266, Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, France; Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, France
| | - R Rey
- Fondation Fondamental, France; INSERM, U1028, CNRS, UMR5292; University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital, Schizophrenia Expert Centre, Lyon, F-69000, France
| | - C Roman
- Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - B Schorr
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
| | - F Schürhoff
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Szöke
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Tessier
- Fondation Fondamental, France; University Department of General Psychiatry, Charles Perrens Hospital, F-33076, Bordeaux, France; CNRS UMR 5287-INCIA, Bordeaux, France
| | - M Urbach
- Fondation Fondamental, France; Versailles Hospital, Department of Adult Psychiatry and Addictology, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157 Le Chesnay, France; DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94, ,807, Villejuif, France
| | - G Wachiche
- Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly, 94, ,000 Créteil, France
| | - A Zinetti-Bertschy
- Fondation Fondamental, France; Strasbourg University Hospital, University of Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg, France
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Improving physical activity and diet in patients with severe mental disorders: Results from the LIFESTYLE multicentric, real-world randomized controlled trial. Psychiatry Res 2022; 317:114818. [PMID: 36088834 DOI: 10.1016/j.psychres.2022.114818] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
Aims of the present study are to test the efficacy of a lifestyle group intervention, compared to a brief psychoeducational intervention, on levels of physical activity and dietary habits in a real-world sample of patients with severe mental disorders. The study, funded by the Italian Ministry of Education, has been carried out in six Italian University psychiatric outpatient units. All patients were randomly assigned to the experimental or control group and were assessed through standardized assessment instruments at baseline and six months after randomization. Of the 401 recruited patients, 43.3% had a diagnosis of bipolar disorder, 29.9% of psychosis and 26.9% of major depression. Patients were mainly female (57%), with a mean age of 45.6±11.8 years. Treated patients have almost 8 times the likelihood to show an increase of the total MET (OR: 8.02; p < .001) and of the walking MET (OR: 7.68; p < .001) and are more likely to increase the weekly consumption of vegetables (OR= 1.98, p < .05) and to reduce that of junk food (OR:0.23; p < .05). The present study support the notion that patients with severe mental disorders can improve their lifestyle behaviours and that, with appropriate support, they can achieve a healthy living.
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Virtual Learning Collaborative Compared to Technical Assistance as a Strategy for Implementing Health Promotion in Routine Mental Health Settings: A Hybrid Type 3 Cluster Randomized Trial. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:1031-1046. [PMID: 35987829 DOI: 10.1007/s10488-022-01215-0] [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: 10/30/2021] [Accepted: 08/03/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Despite widespread use of learning collaboratives, few randomized trials have evaluated their effectiveness as a strategy for implementing evidence based practices. This randomized trial evaluated the effectiveness of a virtual learning collaborative (VLC) in the implementation of a health promotion program for persons with serious mental illness (SMI) aimed at reducing cardiovascular risk reduction in routine mental health settings, compared to routine technical assistance (TA). METHODS Fifty-five mental health provider organizations were recruited to participate in a Hybrid Type 3 cluster randomized implementation-effectiveness trial of the InSHAPE health promotion program for persons with SMI. Sites were stratified by size and randomized prior to implementation to an 18-month group-based VLC with monthly learning sessions or individual site TA with four scheduled conference calls over 18 months. Primary implementation and service outcomes were InSHAPE program fidelity, participation, and reach. Primary clinical outcomes were weight loss, cardiorespiratory fitness, and cardiovascular risk reduction (≥ 5% weight loss or > 50 m increase on the 6-Minute Walk Test). Program fidelity was assessed at 6, 12, and 24 months; program participation and participant-level outcomes were assessed at 3, 6, 9, and 12 months. RESULTS VLC (N = 27) and TA (N = 28) sites were similar in organizational characteristics (all p > 0.05). At 12-month follow-up mean program fidelity score was higher in VLC compared to TA (90.5 vs. 79.1; p = 0.002), with over double the proportion with good fidelity (VLC = 73.9% vs. TA = 34.8%; p = 0.009). Over half of individuals in both VLC and TA achieved cardiovascular risk-reduction at 6-month follow-up (VLC: 51.0%; TA: 53.5%; p = 0.517) and at 12-month follow-up (62% VLC and TA; p = 0.912). At 12-month follow-up VLC compared to TA was associated with greater participation (VLC 69.5% vs. TA 56.4% attending at least 50% of sessions, p = 0.002); larger caseloads (VLC = 16 vs. TA = 11; p = 0.024); greater reach consisting of 45% greater number of participants receiving InSHAPE (VLC = 368 vs. TA = 253), and 58% greater number of participants achieving cardiovascular risk reduction (VLC = 150 vs. TA = 95). CONCLUSION Virtual learning collaboratives compared to routine technical assistance as an implementation strategy for evidence-based health promotion promote greater intervention fidelity, greater levels of intervention participation, greater reach, and a greater number of participants achieving clinically significant risk reduction outcomes, while achieving similarly high levels of intervention effectiveness for participants who completed at least 6 months of the program.
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Cabassa LJ, Stefancic A, Chen JH, Park M, Tuda D, Hawes MR, Guo S. Impact of Moderating Demographic Variables on a Health Intervention for People with Serious Mental Illness. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:952-962. [PMID: 38741792 PMCID: PMC11090479 DOI: 10.1177/10497315221102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Purpose Healthy lifestyle interventions can improve the health of people with serious mental illness (SMI). Little is known whether demographic variables moderate the effectiveness of these interventions on health outcomes. Method Data from an effectiveness trial of a peer-led healthy lifestyle intervention (PGLB) for people with SMI examine whether age, racial/ethnic minoritized status, and gender moderated the effectiveness of PGLB compared to usual care (UC) in achieving clinically significant improvements in weight, cardiorespiratory fitness, and cardiovascular disease (CVD) risk reduction. Results Compared to UC, PGLB was most beneficial for participants age 49 and younger for achieving clinically significant weight loss and from racial/ethnic minoritized communities for achieving clinically significant weight loss and reductions in CVD risk. Conclusions These findings suggest the impact of healthy lifestyle interventions for people with SMI may not be uniform and adaptations may be needed to make these interventions responsive to the needs of diverse populations.
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Affiliation(s)
| | | | - Jun-Hong Chen
- Brown School of Social Work at Washington University in St. Louis
| | - Michael Park
- Brown School of Social Work at Washington University in St. Louis
| | - Daniela Tuda
- Brown School of Social Work at Washington University in St. Louis
| | - Mark R. Hawes
- Brown School of Social Work at Washington University in St. Louis
| | - Shenyang Guo
- Brown School of Social Work at Washington University in St. Louis
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13
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Sunhary De Verville PL, Stubbs B, Etchecopar-Etchart D, Godin O, Andrieu-Haller C, Berna F, Aouizerate B, Capdevielle D, Chereau I, Clauss-Kobayashi J, Coulon N, Dorey JM, Dubertret C, Leignier S, Mallet J, Misdrahi D, Passerieux C, Pignon B, Rey R, Urbach M, Llorca PM, Schürhoff F, Lançon C, Boyer L, Fond G. Recommendations of the Schizophrenia Expert Center network for adequate physical activity in real-world schizophrenia (FACE-SZ). Eur Arch Psychiatry Clin Neurosci 2022; 272:1273-1282. [PMID: 35441901 DOI: 10.1007/s00406-022-01384-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/14/2022] [Indexed: 11/24/2022]
Abstract
The World Health Organization (WHO) recommends adults complete 150-300 min per week of moderate physical activity or 75-150 min of vigorous physical activity or an equivalent combination of both, to optimize health. To explore the factors associated with adequate MVPA in stabilized outpatients with schizophrenia. 425 stabilized outpatients were recruited in the national FACE-SZ cohort between 2015 and 2018 were evaluated with the International Physical Activity Questionnaire and a 1-day long standardized battery. We explored in multivariate analyses the clinical and pharmacological factors associated with MVPA (model 1) and the biological factors and patient-reported outcomes (model 2). Overall, only 86 (20.2%) of the 425 participants achieved the recommended MVPA threshold. In model 1, the adequate MVPA group was associated with younger age, mood stabilizers prescription and adherence to treatment, independent of sex, positive and depressive symptoms, first-generation antipsychotics prescription, anxiolytic medication, and akathisia. In model 2, adequate MVPA was associated with better glycemic and lipidic profile and better physical and psychological well-being, self-esteem, sentimental life, and resilience independently of age, sex, and current psychotic severity. The expert centers recommend the importance of promoting promote effective MVPA programs for stabilized patients with schizophrenia. Interventions studies suggest that MVPA may be a useful strategy to maximize physical and psychological well-being and self-esteem and potentially to prevent or manage metabolic disturbances.
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Affiliation(s)
- Pierre-Louis Sunhary De Verville
- Fondation FondaMental, Créteil, France.,AP-HM, Aix-Marseille Univ, Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Damien Etchecopar-Etchart
- Fondation FondaMental, Créteil, France.,AP-HM, Aix-Marseille Univ, Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Ophélia Godin
- Fondation FondaMental, Créteil, France.,Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 94010, Creteil, France
| | - Christelle Andrieu-Haller
- Fondation FondaMental, Créteil, France.,AP-HM, Aix-Marseille Univ, Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie Générale Et Universitaire, Centre Hospitalier Charles Perrens, 33076 Université de Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France.,INRA, NutriNeuro, University of Bordeaux, U1286, 33076, Bordeaux, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France.,Université Clermont Auvergne, CMP-B, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Julie Clauss-Kobayashi
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Nathalie Coulon
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Jean-Michel Dorey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Université de Paris, AP-HP, Louis Mourier Hospital, Colombes, INSERM UMR 1266, Colombes, France
| | - Sylvain Leignier
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Université de Paris, AP-HP, Louis Mourier Hospital, Colombes, INSERM UMR 1266, Colombes, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie Générale Et Universitaire, Centre Hospitalier Charles Perrens, 33076 Université de Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France.,CNRS UMR 5287-INCIA, Paris, France
| | - Catherine Passerieux
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France.,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, 94807, Villejuif,, France
| | - Baptiste Pignon
- Fondation FondaMental, Créteil, France.,Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 94010, Creteil, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay, France.,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, 94807, Villejuif,, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,Université Clermont Auvergne, CMP-B, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Franck Schürhoff
- Fondation FondaMental, Créteil, France.,Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 94010, Creteil, France
| | - Christophe Lançon
- Fondation FondaMental, Créteil, France.,AP-HM, Aix-Marseille Univ, Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Laurent Boyer
- Fondation FondaMental, Créteil, France.,AP-HM, Aix-Marseille Univ, Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Guillaume Fond
- Fondation FondaMental, Créteil, France. .,AP-HM, Aix-Marseille Univ, Faculté de Médecine-Secteur Timone, EA 3279: CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005, Marseille, France.
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14
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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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15
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Hawes MR, Danforth ML, Jacquelyn Pérez-Flores N, Bochicchio L, Tuda D, Stefancic A, Cabassa LJ. Learning, doing and sticking with it: A qualitative study on achieving clinically significant reduction in cardiovascular disease risk in a healthy lifestyle intervention for people with serious mental illness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2989-e2999. [PMID: 35113479 PMCID: PMC9346096 DOI: 10.1111/hsc.13744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/03/2022] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
People with serious mental illness (SMI; e.g. schizophrenia) have mortality rates two to three times higher than the general population, largely due to a higher prevalence of cardiovascular disease (CVD). Healthy lifestyle interventions can improve the health of people with SMI, but information about why these interventions work for some and not others is scarce. Our study aims to qualitatively explore differences in these two groups' overall experiences and application of the intervention. Data were drawn from a randomised effectiveness trial of a peer-led healthy lifestyle intervention. Qualitative data from interviews and focus groups with 21 participants were linked to their 12-month outcome data. Grounded theory was used to compare the experiences of participants who achieved clinically significant CVD risk reduction (i.e. clinically significant weight loss or clinically significant improvements in cardiorespiratory fitness) versus those who did not. Three qualitative themes: learning, change, sticking with it - differentiated participants who achieved CVD risk reduction and those that did not. Participants achieving CVD risk reduction described learning and applying specific knowledge and skills related to a healthy lifestyle when making health decisions, made healthy concrete changes to diet and physical activity, and stuck with those changes. Participants not achieving clinically significant CVD risk reduction reported surface-level learning about healthy lifestyle practices, difficulty sticking with healthy changes, and were more likely to report ambiguous or no changes. Our findings suggest that healthy lifestyle interventions for people with SMI should provide experiential in-vivo learning experiences while periodically assessing participants' understanding and then tailoring the intervention to their needs. It is important to build self-efficacy for health behaviour changes by creating early perceptions of success, which was found to enhance motivation and sustain behaviour change. Helping people with SMI develop and strengthen their support systems will also be an important factor for building and sustaining health behaviour changes.
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Affiliation(s)
- Mark R Hawes
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | | | | | | | - Daniela Tuda
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
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16
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Robertson C, Aceves-Martins M, Cruickshank M, Imamura M, Avenell A. Does weight management research for adults with severe obesity represent them? Analysis of systematic review data. BMJ Open 2022; 12:e054459. [PMID: 35641006 PMCID: PMC9157335 DOI: 10.1136/bmjopen-2021-054459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Our objective was to determine the extent to which current evidence from long-term randomised controlled trials (RCTs) of weight management is generalisable and applicable to underserved adult groups with obesity (body mass index (BMI) ≥35 kg/m2). METHODS Descriptive analysis of 131 RCTs, published after 1990-May 2017 with ≥1 year of follow-up, included in a systematic review of long-term weight management interventions for adults with BMI ≥35 kg/m2 (the REBALANCE Project). Studies were identified from MEDLINE, EMBASE, PsychINFO, SCI, CENTRAL and from hand searching. Reporting of trial inclusion and exclusion criteria, trial recruitment strategies, baseline characteristics and outcomes were analysed using a predefined list of characteristics informed by the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital)-Plus framework and the UK Equality Act 2010. RESULTS Few (6.1%) trials reported adapting recruitment to appeal to underserved groups. 10.0% reported culturally adapting their trial materials. Only 6.1% of trials gave any justification for their exclusion criteria, yet over half excluded participation for age or mental health reasons. Just over half (58%) of the trials reported participants' race or ethnicity, and one-fifth reported socioeconomic status. Where outcomes were reported for underserved groups, the most common analysis was by sex (47.3%), followed by race or ethnicity (16.8%). 3.1% of trials reported outcomes according to socioeconomic status. DISCUSSION Although we were limited by poor trial reporting, our results indicate inadequate representation of people most at risk of obesity. Guidance for considering underserved groups may improve the appropriateness of research and inform greater engagement with health and social care services. FUNDING National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04). PROSPERO REGISTRATION NUMBER CRD42016040190.
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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17
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Haddad R, Badke D'Andrea C, Ricchio A, Evanoff B, Morrato EH, Parks J, Newcomer JW, Nicol GE. Using Innovation-Corps (I-Corps™) Methods to Adapt a Mobile Health (mHealth) Obesity Treatment for Community Mental Health Settings. Front Digit Health 2022; 4:835002. [PMID: 35721796 PMCID: PMC9197731 DOI: 10.3389/fdgth.2022.835002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background We employed Innovation Corps (I-Corps™) methods to adaptation of a mobile health (mHealth) short-message-system (SMS) -based interactive obesity treatment approach (iOTA) for adults with severe mentall illness receiving care in community settings. Methods We hypothesized "jobs to be done" in three broad stakeholder groups: "decision makers" (DM = state and community clinic administrators), "clinician consumers" (CC = case managers, peer supports, nurses, prescribers) and "service consumers" (SC = patients, peers and family members). Semistructured interviews (N = 29) were recorded and transcribed ver batim and coded based on pragmatic-variant grounded theory methods. Results Four themes emerged across groups: education, inertia, resources and ownership. Sub-themes in education and ownership differed between DM and CC groups on implementation ownership, intersecting with professional development, suggesting the importance of training and supervision in scalability. Sub-themes in resources and intertia differed between CC and SC groups, suggesting illness severity and access to healthy food as major barriers to engagement, whereas the SC group identified the need for enhanced emotional support, in addition to pragmatic skills like menu planning and cooking, to promote health behavior change. Although SMS was percieved as a viable education and support tool, CC and DM groups had limited familiarity with use in clinical care delivery. Conclusions Based on customer discovery, the characteristics of a minimum viable iOTA for implementation, scalability and sustainability include population- and context-specific adaptations to treatment content, interventionist training and delivery mechanism. Successful implementation of an SMS-based intervention will likely require micro-adaptations to fit specific clinical settings.
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Affiliation(s)
- Rita Haddad
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Carolina Badke D'Andrea
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Amanda Ricchio
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Bradley Evanoff
- Center for Healthy Work, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Elaine H. Morrato
- Parkinson School of Health Sciences and Public Health, Loyola University of Chicago, Chicago, IL, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Joseph Parks
- National Council for Mental Wellbeing, Washington, DC, United States
| | - John W. Newcomer
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Thriving Mind South Florida, Miami, FL, United States
| | - Ginger E. Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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18
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Tuda D, Stefancic A, Hawes M, Wang X, Guo S, Cabassa LJ. Correlates of Attendance in a Peer-Led Healthy Lifestyle Intervention for People with Serious Mental Illness Living in Supportive Housing. Community Ment Health J 2022; 58:761-769. [PMID: 34417635 PMCID: PMC8858335 DOI: 10.1007/s10597-021-00881-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
Healthy lifestyle interventions can improve the physical health of people with serious mental illness (SMI; e.g., schizophrenia). Yet, people with SMI report challenges participating in these interventions, thus limiting their potential benefits. This study examined attendance of participants (N = 155), largely comprised of racial and ethnic minorities, in a peer-led healthy lifestyle intervention living in supportive housing. A logistic regression model was used to identify correlates associated with attendance. Results indicated that females, those with at least a high school education, and a diagnosis of schizophrenia were more likely to attend. In contrast, the odds of attending at least one session were significantly lower for those who reported any drug use and for those who rated their health as good or excellent. Our findings indicate certain subgroups of people with SMI could benefit from tailored motivational strategies and supports to improve their participation in healthy lifestyle interventions. clinicaltrials.gov (NCT02175641).
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Affiliation(s)
- Daniela Tuda
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Mark Hawes
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Xiaoyan Wang
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Shenyang Guo
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work at Washington, University in St. Louis, Goldfarb Hall, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
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19
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Pape LM, Adriaanse MC, Kol J, van Straten A, van Meijel B. Patient-reported outcomes of lifestyle interventions in patients with severe mental illness: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:261. [PMID: 35418082 PMCID: PMC9006587 DOI: 10.1186/s12888-022-03854-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/11/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lifestyle interventions for severe mental illness (SMI) are known to have small to modest effect on physical health outcomes. Little attention has been given to patient-reported outcomes (PROs). AIM To systematically review the use of PROs and their measures, and quantify the effects of lifestyle interventions in patients with SMI on these PROs. METHODS Five electronic databases were searched (PubMed/Medline, Embase, PsycINFO, CINAHL, and Web of Science) from inception until 12 November 2020 (PROSPERO: CRD42020212135). Randomised controlled trials (RCTs) evaluating the efficacy of lifestyle interventions focusing on healthy diet, physical activity, or both for patients with SMI were included. Outcomes of interest were PROs. RESULTS A total of 11.267 unique records were identified from the database search, 66 full-text articles were assessed, and 36 RCTs were included, of which 21 were suitable for meta-analyses. In total, 5.907 participants were included across studies. Lifestyle interventions had no significant effect on quality of life (g = 0.13; 95% CI = - 0.02 to 0.27), with high heterogeneity (I2 = 68.7%). We found a small effect on depression severity (g = 0.30, 95% CI = 0.00 to 0.58, I2 = 65.2%) and a moderate effect on anxiety severity (g = 0.56, 95% CI = 0.16 to 0.95, I2 = 0%). DISCUSSION This meta-analysis quantifies the effects of lifestyle interventions on PROs. Lifestyle interventions have no significant effect on quality of life, yet they could improve mental health outcomes such as depression and anxiety symptoms. Further use of patient-reported outcome measures in lifestyle research is recommended to fully capture the impact of lifestyle interventions.
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Affiliation(s)
- Laura M. Pape
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marcel C. Adriaanse
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jelle Kol
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Annemieke van Straten
- grid.12380.380000 0004 1754 9227Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Berno van Meijel
- grid.448984.d0000 0003 9872 5642Department of Health, Sports & Welfare, Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam UMC (VUmc). Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands
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20
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Aschbrenner KA, Naslund JA, Gorin AA, Mueser KT, Browne J, Wolfe RS, Xie H, Bartels SJ. Group Lifestyle Intervention With Mobile Health for Young Adults With Serious Mental Illness: A Randomized Controlled Trial. Psychiatr Serv 2022; 73:141-148. [PMID: 34189933 DOI: 10.1176/appi.ps.202100047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evidence-based lifestyle interventions tailored to young adults with serious mental illness are needed to reduce their cardiometabolic risk. This study evaluated the effectiveness of a group lifestyle intervention ("PeerFIT") enhanced with mobile health (mHealth) compared with one-on-one mHealth coaching (basic education supported by activity tracking [BEAT]) for young adults with serious mental illness who were overweight or obese. METHODS Participants were young adults ages 18-35 years with serious mental illness and a body mass index ≥25 kg/m2, who were randomly assigned to PeerFIT or BEAT. Research staff collected data at baseline and at 6 and 12 months. Main outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of >50 m on the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS Participants were 150 young adults with a mean ± SD body mass index of 37.1±7.4. Intent-to-treat analyses revealed no significant between-group difference for weight-loss, CRF, or CVD outcomes at 6 and 12 months. Participants in both conditions achieved clinically significant CVD risk reduction, weight loss, and CRF from baseline to 6 and 12 months, and all these improvements were statistically significant (p<0.01). CONCLUSION The PeerFIT group lifestyle intervention was not superior to one-on-one mHealth coaching in achieving clinically significant changes in weight, CRF, and CVD risk reduction. Although both interventions improved outcomes, low-intensity mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - John A Naslund
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Amy A Gorin
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Kim T Mueser
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Julia Browne
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Rosemarie S Wolfe
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Haiyi Xie
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Stephen J Bartels
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
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21
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Kirschner V, Lamp N, Dinc Ü, Becker T, Kilian R, Mueller-Stierlin AS. The evaluation of a physical health promotion intervention for people with severe mental illness receiving community based accommodational support: a mixed-method pilot study. BMC Psychiatry 2022; 22:6. [PMID: 34983452 PMCID: PMC8728992 DOI: 10.1186/s12888-021-03640-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Unhealthy lifestyle constitutes a cause of increased morbidity and mortality in people with severe mental illness. The aim of this mixed-method pilot study was to investigate the feasibility and preliminary effectiveness of an intervention to promote a health-conscious lifestyle in comparison to care as usual among people with severe mental illness receiving accommodational support in community settings. METHODS This was a prospective, quasi-experimental, controlled study over four six-month assessment points (t0, + 6 months, + 12 months, + 18 months) with 70 persons with severe mental illness receiving community based accommodational support. Mental health staff members of the housing facilities were trained in Motivational Interviewing and conducted a six-week health course with the intervention group participants in addition to care as usual. Next to the primary outcome - self-rated physical well-being (FEW 16) - anthropometric parameters and unhealthy behaviours (diet, physical activity, alcohol and tobacco consumption, and oral hygiene) were examined. Effectiveness analysis was conducted using mixed-effects regression models with propensity score adjustment to control for selection bias. One year after the end of the intervention, semi-standardized expert interviews were conducted with 12 of these employees and evaluated by content analysis. RESULTS The qualitative interviews with mental health staff underline the intervention's feasibility in people with severe mental illness in sheltered housing, and the acceptability of and satisfaction with the intervention among mental health workers. But in this pilot study no superiority of the HELPS intervention compared to routine care could be demonstrated in terms of the investigated outcomes. CONCLUSIONS The findings of this pilot study underscore the feasibility and acceptability of health promotion programmes based on Motivational Interviewing and highlight the need to further develop multi-modal programs according to the needs of the target group. Long-term and sustainable support for healthy lifestyles of people with severe mental illness receiving community mental health care requires multi-modal concepts and organisational change. TRIAL REGISTRATION DRKS00011659 , date of registration was 2017/02/15; retrospectively registered as date of first enrolment was 2017/01/24.
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Affiliation(s)
- Viola Kirschner
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, University of Ulm, Lindenallee 2, 89312 Günzburg, Germany
| | - Natalie Lamp
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, University of Ulm, Lindenallee 2, 89312 Günzburg, Germany
| | - Ümmügülsüm Dinc
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, University of Ulm, Lindenallee 2, 89312 Günzburg, Germany
| | - Thomas Becker
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, University of Ulm, Lindenallee 2, 89312 Günzburg, Germany
| | - Reinhold Kilian
- grid.6582.90000 0004 1936 9748Department of Psychiatry II, University of Ulm, Lindenallee 2, 89312 Günzburg, Germany
| | - Annabel Sandra Mueller-Stierlin
- Department of Psychiatry II, University of Ulm, Lindenallee 2, 89312, Günzburg, Germany. .,Institute of Epidemiology and Medical Biometry, University of Ulm, Schwabstraße 13, 89075, Ulm, Germany.
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22
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Aschbrenner KA, Naslund JA, Salwen-Deremer JK, Browne J, Bartels SJ, Wolfe RS, Xie H, Mueser KT. Sleep quality and its relationship to mental health, physical health and health behaviours among young adults with serious mental illness enrolled in a lifestyle intervention trial. Early Interv Psychiatry 2022; 16:106-110. [PMID: 33594828 PMCID: PMC10047807 DOI: 10.1111/eip.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 01/28/2023]
Abstract
AIM To characterize subjective sleep quality and examine its associations with mental health, physical health and health behaviours in a transdiagnostic sample of young adults with serious mental illness (SMI) enrolled in a lifestyle intervention trial. METHODS Baseline data from a lifestyle intervention trial with young adults (ages 18-35 years) with SMI included the Pittsburgh Sleep Quality Index (PSQI), mental health, physical health and health behaviour outcomes. Descriptive statistics and multiple linear regression were used in analyses. RESULTS Of 150 participants, 76% were categorized with poor sleep quality. Depressive symptoms were significantly associated with sleep quality (β = .438, p < .001); however, no association was found with physical health and health behaviours. CONCLUSIONS Young adults with SMI enrolled in lifestyle interventions may benefit from treatment that addresses sleep as part of a comprehensive approach to health promotion with attention to the role of depressive symptoms in sleep quality.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jessica K Salwen-Deremer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Julia Browne
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, North Carolina
| | - Stephen J Bartels
- Department of Medicine, Massachusetts General Hospital, Mongan Institute, Boston, Massachusetts
| | - Rosemarie S Wolfe
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Haiyi Xie
- Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Kim T Mueser
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts.,Department of Psychological & Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts
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23
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Lee C, Piernas C, Stewart C, Michalopoulou M, Hajzadeh A, Edwards R, Aveyard P, Waite F. Identifying effective characteristics of behavioral weight management interventions for people with serious mental illness: A systematic review with a qualitative comparative analysis. Obes Rev 2022; 23:e13355. [PMID: 34672069 PMCID: PMC8952200 DOI: 10.1111/obr.13355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
Abstract
People with serious mental illness (SMI) have identified barriers to engaging in behavioral weight management interventions (BWMIs). We assessed whether BWMIs that addressed these barriers were more effective. First, we systematically reviewed qualitative literature and used a thematic analysis to identify the characteristics of BWMIs that promote engagement for adults with SMI. Second, we systematically reviewed randomized controlled trials (RCTs) of BWMIs in adults with SMI. Data on the characteristics that promoted engagement and weight outcomes were extracted. We then used a crisp-set qualitative comparative analysis (CsQCA) to identify which characteristics were associated with weight loss. For the qualitative review, 20 studies in 515 people with SMI were analyzed and nine characteristics were reported to promote engagement in BWMIs. For the systematic review, 34 RCTs testing 36 interventions in 4305 participants were included. The active interventions resulted in more weight loss (mean = -4.37 to +1 kg at 6 weeks to 18 months follow-up) compared with controls (-1.64 to +3.08 kg). The CsQCA showed BWMIs that offered regular contact, tools to support enactment, and tailored materials were associated with effectiveness. As these are all supplementary strategies, it may be possible to augment BWMIs available for the general population to engage people with SMI.
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Affiliation(s)
- Charlotte Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Cristina Stewart
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Anisa Hajzadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Rhiannon Edwards
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.,Bassetlaw Hospital, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Worksop, Nottinghamshire, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, Oxfordshire, UK.,Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
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24
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McGinty EE, Presskreischer R, Breslau J, Brown JD, Domino ME, Druss BG, Horvitz-Lennon M, Murphy KA, Pincus HA, Daumit GL. Improving Physical Health Among People With Serious Mental Illness: The Role of the Specialty Mental Health Sector. Psychiatr Serv 2021; 72:1301-1310. [PMID: 34074150 PMCID: PMC8570967 DOI: 10.1176/appi.ps.202000768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
People with serious mental illness die 10-20 years earlier, compared with the overall population, and the excess mortality is driven by undertreated physical health conditions. In the United States, there is growing interest in models integrating physical health care delivery, management, or coordination into specialty mental health programs, sometimes called "reverse integration." In November 2019, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness convened a forum of 25 experts to discuss the current state of the evidence on integrated care models based in the specialty mental health system and to identify priorities for future research, policy, and practice. This article summarizes the group's conclusions. Key research priorities include identifying the active ingredients in multicomponent integrated care models and developing and validating integration performance metrics. Key policy and practice recommendations include developing new financing mechanisms and implementing strategies to build workforce and data capacity. Forum participants also highlighted an overarching need to address socioeconomic risks contributing to excess mortality among adults with serious mental illness.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Rachel Presskreischer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Joshua Breslau
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Jonathan D Brown
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marisa Elena Domino
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Benjamin G Druss
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marcela Horvitz-Lennon
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Karly A Murphy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Harold Alan Pincus
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Gail L Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
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25
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Choudhury A, Asan O. Impact of using wearable devices on psychological Distress: Analysis of the health information national Trends survey. Int J Med Inform 2021; 156:104612. [PMID: 34649113 DOI: 10.1016/j.ijmedinf.2021.104612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 01/11/2023]
Abstract
AIM This study explores the possible impact of wearables on psychological distress and their implications on designs. METHOD The study conceptualizes and tests two exploratory models by analyzing the US-based Health Information National Trends Survey of 2019 and 2020. Six variants from the databases were used in the study as predictors. We used models 4 and 6 of the Hayes PROCESS macros to test our conceptual parallel and sequential mediation models, respectively. RESULTS The finding indicates significant and negative indirect effects of 'Use of wearable device' on 'Psychological distress.' In parallel mediation models, 'self-care' and 'health perception' were noted to be significant mediators. Wearable devices were associated with improved 'Health perception,' 'Self-care,' and longer 'workout duration,', which in turn helped reduce 'psychological distress' (better mental health). The sequential mediation model captured the indirect effect of 'Use of wearable device' on 'Psychological distress' when sequentially mediated by 'workout duration,' 'BMI,' 'self-care,' and 'health perception' in the given order. CONCLUSION As the adoption of digital wearables is increasing due to their growing potential to augment physiological and psychosocial health, it is critical that these technologies are designed to address the needs of users from diverse backgrounds (race, education level, age).
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Affiliation(s)
- Avishek Choudhury
- Stevens Institute of Technology, School of Systems and Enterprises, United States.
| | - Onur Asan
- Stevens Institute of Technology, School of Systems and Enterprises, United States.
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26
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Hawes MR, Roth KB, Wang X, Stefancic A, Weatherly C, Cabassa LJ. Ideal Cardiovascular Health in Racially and Ethnically Diverse People with Serious Mental Illness. J Health Care Poor Underserved 2021; 31:1669-1692. [PMID: 33416746 DOI: 10.1353/hpu.2020.0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease is a primary contributor to premature death among people with serious mental illness (SMI). This study used baseline data (N=314) from an effectiveness trial testing a healthy lifestyle intervention for racial/ethnically diverse participants with overweight/obesity and SMI living in supportive housing. We examined the prevalence and correlates of a modified version of the American Heart Association (AHA) metric of ideal cardiovascular health (ICVH). Five AHA ICVH metrics (smoking, body mass index, diet, physical activity, and blood pressure) were used to create a composite ICVH score. The mean ICVH score was 3.15 (range 0-8). Multivariate analysis indicated that higher ICVH scores were associated with lifetime cancer diagnosis and better cardiorespiratory fitness. Lower scores were associated with female gender, racial/ethnic minority status, and antipsychotic use, suggesting that these subgroups of people with SMI may benefit from targeted screening and interventions to improve their cardiovascular health.
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27
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Aschbrenner KA, Mueller NM, Banerjee S, Bartels SJ. Applying an Equity Lens to Characterizing the Process and Reasons for an Adaptation to an Evidenced-based Practice. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34514417 PMCID: PMC8428660 DOI: 10.1177/26334895211017252] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Adaptations to evidence-based practices (EBPs) are common but can impact implementation and patient outcomes. In our prior research, providers in routine care made a fidelity-inconsistent adaptation to an EBP that improved health outcomes in people with serious mental illness (SMI). The purpose of this study was to characterize the process and reasons for the adaptation using a framework for reporting adaptations and modifications to EBPs, with a focus on equity. Methods This study used qualitative data collected during a national implementation of the InSHAPE EBP addressing obesity in persons with SMI. We reviewed transcripts from five behavioral health organizations that made a successful fidelity-inconsistent adaptation to a core component of InSHAPE that was associated with cardiovascular risk reduction. We coded the data using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) with an emphasis on exploring whether the adaptation addressed inequities in using the EBP related to social determinants of health. Results Across the five agencies, the fidelity-inconsistent adaptation was characterized as unplanned and reactive in response to challenges InSHAPE teams experienced delivering the intervention in community fitness facilities as intended. In all cases, the goal of the adaptation was to improve intervention access, feasibility and fit. Social and economic disadvantage were noted obstacles to accessing fitness facilities or gyms among participants with SMI, which led agencies to adapt the program by offering sessions at the mental health center. Conclusions Findings from this study show the advantages of applying a health equity lens to evaluate how obstacles such as poverty and discrimination influence EBP adaptations. Recommendations can also assist researchers and community partners in making proactive decisions about allowable adaptations to EBPs.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | | | - Souvik Banerjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India
| | - Stephen J Bartels
- The Mongan Institute, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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28
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Aschbrenner KA, Naslund JA, Reed JD, Fetter JC. Renewed call for lifestyle interventions to address obesity among individuals with serious mental illness in the COVID-19 era and beyond. Transl Behav Med 2021; 11:1359-1364. [PMID: 34160055 DOI: 10.1093/tbm/ibab076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Behavioral health has the opportunity to lead the way in using lifestyle interventions to address obesity and health disparities in people with serious mental illness (SMI) in the COVID-19 era. Evidence-based interventions for weight loss in individuals with SMI exist, and the field has developed strategies for implementing these interventions in real-world mental health care settings. In addition to promoting weight loss, lifestyle interventions have the potential to address social isolation and loneliness and other patient-centered outcomes among individuals with SMI, which will be especially valuable for mitigating the growing concerns about loneliness attributed to the COVID-19 pandemic restrictions on in-person encounters. In this commentary, we discuss practice, policy, and research implications related to using evidence-based lifestyle interventions for individuals with SMI during the COVID-19 pandemic and sustaining these programs in the long-term.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jeffrey D Reed
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Jeffrey C Fetter
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
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29
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Stefancic A, Bochicchio L, Tuda D, Gurdak K, Cabassa LJ. Participant Experiences With a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness. Psychiatr Serv 2021; 72:530-538. [PMID: 33657839 PMCID: PMC8500678 DOI: 10.1176/appi.ps.202000311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the experiences of individuals with serious mental illness who were predominantly Black, were living in supportive housing, and participated in the Peer-Led Group Lifestyle Balance (PGLB) intervention. The authors examined how participants engaged in the process of behavior change and applied intervention concepts. METHODS Focus groups and interviews with 63 participants explored their motivation for engaging with PGLB, challenges to behavior change, and how they integrated intervention strategies into their lives. Interviews were transcribed and analyzed with grounded theory. RESULTS A grounded model summarized the description of the cycle of behavior change and provided insight into participants' decision-making processes. Challenges to engaging in healthy lifestyle change were related to participants' general medical health, time constraints, lack of knowledge, difficulties breaking old habits and changing self-perceptions, mood state, and the social-physical environment. Participants applied many intervention strategies, such as addressing problematic social cues, contexts, and food associations; planning ahead; starting with smaller changes; portion control; food substitution; mindful eating; and integrating changes into their daily lives. They reported various behavior changes with respect to eating and physical activity and more limited shifts in self-monitoring. CONCLUSIONS Improving the health of people with serious mental illness will require expanding their access to healthy lifestyle interventions in community-based settings. The findings suggest that future interventions should expand support for self-monitoring, meal planning, tailored physical activity, and advocacy. Such interventions should also enhance participants' understanding of the corresponding impact of changes on weight loss and emphasize subjective wellness outcomes to maintain motivation.
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Affiliation(s)
- Ana Stefancic
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Lauren Bochicchio
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Daniela Tuda
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Kristen Gurdak
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
| | - Leopoldo J Cabassa
- Department of Psychiatry (Stefancic) and School of Nursing (Bochicchio), Columbia University, New York City; Brown School of Social Work at Washington University in St. Louis, St. Louis (Tuda, Cabassa); Silver School of Social Work, New York University, New York City (Gurdak)
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Cabassa LJ, Stefancic A, Lewis-Fernández R, Luchsinger J, Weinstein LC, Guo S, Palinkas L, Bochicchio L, Wang X, O'Hara K, Blady M, Simiriglia C, Medina McCurdy M. Main Outcomes of a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness in Supportive Housing. Psychiatr Serv 2021; 72:555-562. [PMID: 33334158 PMCID: PMC8607694 DOI: 10.1176/appi.ps.202000304] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The effectiveness of the Peer-led Group Lifestyle Balance (PGLB) intervention, a 12-month manualized healthy lifestyle intervention delivered by peer specialists, was investigated in a sample of persons with serious mental illness who were overweight or obese and living in supportive housing. METHODS The authors randomly assigned 314 participants from three supportive housing agencies to PGLB or usual care, with assessments at baseline and 6, 12, and 18 months. Outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of ≥50 meters in the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS Most participants were from racial-ethnic minority groups (82%, N=255). The mean±SD baseline weight of this sample was 218.8±54.0 pounds, and the body mass index was 33.7±7.2. Compared with the usual care group, a larger proportion of the PGLB group achieved clinically significant changes in study outcomes at 12 and 18 months, but none of these changes was statistically significant. Outcomes differed by site: two sites reported no significant differences between the two groups, and one reported that PGLB significantly outperformed usual care on clinically significant weight loss at 18 months and CVD risk reduction at 6 and 12 months. CONCLUSIONS The null findings indicate that PGLB was not superior to usual care in helping participants achieve clinically significant changes in weight, CRF, and CVD risk reduction at 12 and 18 months. Questions remain regarding how PGLB works, for whom, and in which settings.
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Affiliation(s)
- Leopoldo J Cabassa
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Ana Stefancic
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Roberto Lewis-Fernández
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - José Luchsinger
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lara Carson Weinstein
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Shenyang Guo
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lawrence Palinkas
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Lauren Bochicchio
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Xiaoyan Wang
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Kathleen O'Hara
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Michael Blady
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Christine Simiriglia
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
| | - Monica Medina McCurdy
- Brown School at Washington University in St. Louis, St. Louis (Cabassa, Guo, Wang); Department of Psychiatry, Columbia University, New York City (Stefancic, Lewis-Fernández); New York State Psychiatric Institute, New York City (Lewis-Fernández); Department of Medicine, Columbia University Medical Center, New York City (Luchsinger); Department of Family and Community Medicine, Jefferson Medical College, Philadelphia (Weinstein); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); School of Nursing, Columbia University, New York City (Bochicchio); School of Social Work, Columbia University, New York City (O'Hara); The Bridge, New York City (Blady); Pathways to Housing PA, Philadelphia (Simiriglia); Project Home, Stephen Klein Wellness Center, Philadelphia (McCurdy)
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Gallagher P, Boland C, McClenaghan A, Fanning F, Lawlor E, Clarke M. Improved self-esteem and activity levels following a 12-week community activity and healthy lifestyle programme in those with serious mental illness: A feasibility study. Early Interv Psychiatry 2021; 15:367-373. [PMID: 32337860 DOI: 10.1111/eip.12965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 02/25/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Those with serious mental illness (SMI) including both psychotic and affective disorders are recognized to have a premature mortality compared to the general population, at least in part due to elevated cardiovascular risk profile. AIM To examine the effect of a 12-week, pragmatic, sustainable, low-cost intervention involving community activity, nutritional advice and exercise that could be accessible to patients attending a community clinic. METHODS Participants (N = 35) with SMI attending a community mental health service who were considered at risk of metabolic syndrome were referred by their clinical teams to a specialized healthy activity and nutritional programme. The intervention involved participation in exercise, dietary education and targeted lifestyle advice focused on community activities. Data on physical health and clinical parameters were collected pre- and post-intervention. RESULTS Physical activity increased following the intervention along with a statistically significant increase in self-esteem scores. There was no significant reduction in body mass index or lowering of anxiety and depression scores. CONCLUSIONS It is feasible to develop a relatively low-cost, community-based physical activity programme, integrating both nutritional advice and healthy activities. This may lead to improved outcomes in cardiovascular risk profile and improved life expectancy.
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Affiliation(s)
- Peter Gallagher
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Cailín Boland
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Aisling McClenaghan
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Felicity Fanning
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Elizabeth Lawlor
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Mary Clarke
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Browne J, Battaglini C, Jarskog LF, Sheeran P, Abrantes AM, McDermott J, Elliott T, Gonzalez O, Penn DL. Targeting Physical Health in Schizophrenia: Results from the Physical Activity Can Enhance Life (PACE-Life) 24-Week Open Trial. Ment Health Phys Act 2021; 20:100393. [PMID: 34178113 PMCID: PMC8224902 DOI: 10.1016/j.mhpa.2021.100393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Poor health and low cardiorespiratory fitness (CRF) contribute substantially to the shortened lifespan of individuals with schizophrenia spectrum disorders (SSDs). Increasing physical activity has demonstrated value; however, there are limited interventions that are accessible and adequately address motivational challenges. This paper reports on an open trial of Physical Activity Can Enhance Life (PACE-Life), a motivational theory-based manualized multicomponent walking intervention. The primary aim was to examine the feasibility of implementing PACE-Life through meeting the recruitment target (n=14), attendance and adherence rates, and participant feedback. The secondary aim was to assess the impact of PACE-Life on intermediate targets (autonomous motivation and satisfaction of autonomy, relatedness, and competence needs), proximal outcomes (Fitbit steps/day and minutes spent walking), the primary outcome (CRF), and secondary outcomes (loneliness, symptoms, resting heart rate, blood pressure, weight, body mass index, and hip and waist circumference). Seventeen participants with SSDs enrolled in a 24-week open trial. Assessments occurred at baseline, midpoint, post-test, and one-month follow-up. The recruitment target was exceeded, the group attendance rate was 34%, Fitbit adherence rate was 54%, and participant feedback indicated satisfaction with the intervention as well as a positive group environment. There was a large improvement in the primary outcome of CRF with 77% of participants achieving clinically significant improvement at post-test. Small and medium effect size increases were observed in autonomous motivation and satisfaction of autonomy, relatedness, and competence needs. Fitbit data and secondary outcomes generally remained unchanged or worsened during the intervention. Results from this open trial indicate that PACE-Life leads to meaningful changes in CRF among people with SSDs.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Claudio Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L. Fredrik Jarskog
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jessica McDermott
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tonya Elliott
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Oscar Gonzalez
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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"Being There" vs "Being Direct:" Perspectives of Persons with Serious Mental Illness on Receiving Support with Physical Health from Peer and Non-Peer Providers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:539-550. [PMID: 33479782 DOI: 10.1007/s10488-020-01098-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
Individuals with serious mental illness (SMI) face significant health disparities and multiple barriers to engaging in health behavior change. To reduce these health disparities, it is necessary to enhance the support individuals with SMI receive through the collaboration of different healthcare providers. This study explored how people with SMI living in supportive housing perceived receiving support from peer and non-peer providers for their physical health. Qualitative interviews were conducted with 28 participants receiving a peer-led healthy lifestyle intervention in the context of a randomized trial in supportive housing agencies. Interviews explored participants' experiences working with the healthy lifestyle peer specialist and a non-peer provider who assisted them with health. Interviews were audio recorded, transcribed, and analyzed using strategies rooted in grounded theory. Participants viewed their relationships with peer and non-peer providers positively, but described differences in the approach to practice, power dynamics present, and how they identified with each provider. Participants described peers as process-oriented while non-peer staff as task-oriented, focusing on accomplishing concrete objectives. Each provider sought to boost participants' motivation, but peers built hope by emphasizing the possibility of change, while non-peer providers emphasized the consequences of inaction. Participants related to peer staff through shared experiences, while identifying the importance of having a shared treatment goal with their non-peer provider. Overall, participants appreciated the unique roles of both peer and non-peer staff in supporting their health. Study findings have implications for integrating the use of peer-based health interventions to improve the health of people with SMI.
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Musings on methods and modalities in the study and care of older adults with serious mental illness. Int Psychogeriatr 2020; 32:1401-1403. [PMID: 33377864 DOI: 10.1017/s1041610220000939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Griffiths H. The Acceptability and Feasibility of Using Text Messaging to Support the Delivery of Physical Health Care in those Suffering from a Psychotic Disorder: a Review of the Literature. Psychiatr Q 2020; 91:1305-1316. [PMID: 32970312 PMCID: PMC7593303 DOI: 10.1007/s11126-020-09847-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Those suffering with serious mental illness (SMI), such as psychotic disorders, experience life expectancy 15 years shorter than the general population. Cardiovascular disease is the biggest cause of death in those with psychotic disease and many risk factors may be limited by healthy lifestyle choices. Text messaging interventions represent mobile health (mHealth), a nascent way to deliver physical health care to those suffering with a psychotic disorder. This paper aims to review the literature on the feasibility of text messaging to support the delivery of physical health care in those with a psychotic disorder. A thorough electronic database literature review of Medline via Ovid, Embase, APA Psycinfo, Scopus, Cochrane and Web of Science was conducted. Articles were included if text messaging was used as an intervention targeting the physical health of patients with psychotic disorders. A final sample of 11 articles satisfied the eligibility criteria, of which, 3 were ongoing randomised controlled trials. Of the 8 completed trials, all demonstrated the promising feasibility of text messaging, assessed via quotes, conversation samples, response rates, questionnaires or directly based on physical results. 36% of studies analysed those with schizophrenia or schizoaffective disorder, 55% with SMI and 9% with schizophrenia and psychotic disorders, mood disorders or anxiety disorders. Text messaging was used as motivation or reminders (91%), service delivery (27%) or social support (27%) with studies targeting multiple themes simultaneously. This review highlights compelling evidence for the feasibility of text messaging for improvement of physical health in those suffering with psychotic disorders.
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"Looking Forward": a qualitative evaluation of a physical activity program for middle-aged and older adults with serious mental illness. Int Psychogeriatr 2020; 32:1449-1456. [PMID: 31455434 PMCID: PMC7047554 DOI: 10.1017/s1041610218002004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Older adults with serious mental illness (SMI) often have poor physical health in addition to serious mental health issues. Sustained engagement in a group physical activity program may provide necessary physical and mental health benefits. The purpose of this report is to describe participants' feedback about a video game-based group physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA). In particular, we wanted to understand what worked about the program, what was not ideal, and how it impacted their lives. DESIGN Semi-structured interviews were collected and analyzed with grounded theory methodology. SETTING Mental health facility. PARTICIPANTS Sixteen older adults with SMI. MEASUREMENTS Participants played an active video game for 50-minute sessions, three times a week for 10 weeks. Qualitative interviews were conducted with 16 participants upon completion of the program. RESULTS Participants expressed enthusiasm for the physical activity program, indicating it was an activity that they looked forward to doing. The results of the study provide insight into how the program may be implemented into practice at mental health facilities. Three implementation to practice categories were identified: (1) programmatic considerations, such as when to hold the groups and where; (2) the critical importance of staff involvement; and (3) harnessing patients' interest in the program. CONCLUSION Our results suggest that engagement in an intense video game-based group physical activity program has a positive impact on participants' overall health. The group atmosphere, staff involvement, availability of the program at a mental health facility, and health benefits were critical.
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Evans-Hudnall G, Odafe MO, Johnson A, Armenti N, O'Neil J, Lawson E, Trahan LH, Rassu FS. Using an Adjunctive Treatment to Address Psychological Distress in a National Weight Management Program: Results of an Integrated Pilot Study. Mil Med 2020; 185:e1662-e1670. [PMID: 32728734 DOI: 10.1093/milmed/usaa145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Obesity is highly comorbid with psychological symptoms in veterans, particularly post-traumatic stress disorder (PTSD), depression, and anxiety. Obese veterans with comorbid psychological symptoms often display suboptimal weight loss and poor physical functioning when participating in weight management programs. The MOVE! program aims to increase healthy eating and physical activity to promote weight loss in obese veterans. Adequately addressing psychological barriers is necessary to maximize outcomes in MOVE! for veterans with PTSD, depression, and anxiety. We examined the preliminary outcomes of administering the Healthy Emotions and Improving Health BehavioR Outcomes (HERO) intervention. HERO is adjunctive cognitive-behavioral therapy to MOVE! that addresses PTSD, depression, and anxiety symptom barriers to engagement in physical activity. MATERIALS AND METHODS All recruitment and study procedures were approved by the institutional review board and research and development committees of the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston, Texas. Participants gave written informed consent before enrollment. Thirty-four obese veterans with a diagnosis of PTSD, depression, and/or anxiety who were attending MOVE! were assigned to the 8-session HERO group or the usual care (UC) group. Veterans completed assessments of PTSD, depression and anxiety symptoms, physical activity, physical functioning, and weight at baseline, 8 and 16 weeks post treatment. Changes from baseline to 8- and 16-week follow-up on the self-report and clinician-rated measures were assessed, using independent samples t-tests and analyses of covariance. RESULTS At 8 weeks post treatment, participants in the HERO group had significantly higher step counts per day than participants in the UC group. Similarly, at 16 weeks post-treatment, participants in the HERO group continued to experience a significant increase in daily steps taken per day, as well as statistically and clinically significantly lower scores on the depression symptom and PTSD symptom severity. Participants in the HERO group also demonstrated significantly higher scores on the physical functioning inventory than participants in the UC group (44.1 ± 12.1 vs. 35.7 ± 10.7, P = 0.04) at 16 weeks post treatment. CONCLUSIONS Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. Providing an adjunctive treatment to MOVE! that addresses psychological distress has potential benefits for psychological symptom reduction, engagement in healthy dietary habits, and greater physical activity for individuals who traditionally experience barriers to making positive weight management changes.
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Affiliation(s)
- Gina Evans-Hudnall
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030.,VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center)
| | - Mary O Odafe
- Department of Clinical Psychology, University of Houston, Heyne building # 126, Houston, TX 77204
| | - Adrienne Johnson
- William S. Middleton Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705.,University of Wisconsin Center for Tobacco Research and Intervention, 1930 Monroe St., #200, Madison, WI 53711
| | - Nicholas Armenti
- Department of Clinical Psychology, University of Houston, Heyne building # 126, Houston, TX 77204
| | - Jennifer O'Neil
- Department of Psychiatry and Behavioral Medicine, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030
| | - Evan Lawson
- Department of Counseling Psychology, University of North Texas, 1155 Union Circle #311280, Denton, Texas 76203-5017
| | - Lisa H Trahan
- Trahan Counseling, 631 Mill Street, Suite 101 San Marcos, Texas 78666
| | - Fenan S Rassu
- Department of Psychiatry and Behavioral Medicine, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030
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Speyer H, Jakobsen AS, Westergaard C, Nørgaard HCB, Jørgensen KB, Pisinger C, Krogh J, Hjorthøj C, Nordentoft M, Gluud C, Correll CU. Lifestyle Interventions for Weight Management in People with Serious Mental Illness: A Systematic Review with Meta-Analysis, Trial Sequential Analysis, and Meta-Regression Analysis Exploring the Mediators and Moderators of Treatment Effects. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:350-362. [PMID: 31522170 DOI: 10.1159/000502293] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serious mental illness (SMI) reduces life expectancy, primarily due to somatic comorbidity linked to obesity. Meta-analyses have found beneficial effects of lifestyle interventions in people with SMI and recommended their implementation to manage obesity. OBJECTIVE The objective of this systematic review was to assess the benefits and harms of individualized lifestyle interventions for weight in people diagnosed with SMI and to explore potential mediators and moderators of the effect. METHODS The protocol was registered at PROSPERO (CRD42016049093). Randomized clinical trials (RCTs) assessing the effect of individualized lifestyle interventions on weight management in people with SMI were included. Primary outcomes were differences in endpoint body mass index (BMI) and the proportion achieving clinically relevant weight loss (≥5%). Secondary outcomes included quality of life, cardiometabolic risk factors, and adverse effects. RESULTS We included 41 RCTs (n = 4,267). All trials were at high risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. The experimental interventions reduced the mean difference in BMI by -0.63 kg/m2 (95% confidence interval [CI] = -1.02 to -0.23; p = 0.002; I2 = 70.7%) compared to the control groups. At postintervention follow-up (17 RCTs), the effect size remained similar but was no longer significant (BMI = -0.63 kg/m2; 95% CI = -1.30 to 0.04; p = 0.07; I2 = 48.8%). The risk ratio for losing ≥5% of baseline weight was 1.51 (95% CI = 1.07-2.13; p = 0.02) compared to the control groups. GRADE showed very low or low quality of evidence. CONCLUSION There is a statistically significant, but clinically insignificant, mean effect of individualized lifestyle interventions for weight reduction in people with SMI.
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Affiliation(s)
- Helene Speyer
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark,
| | - Ane Storch Jakobsen
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Casper Westergaard
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | | | | | - Charlotta Pisinger
- Research Center for Prevention and Health, Department 84-85, Glostrup University Hospital, Glostrup, Denmark
| | - Jesper Krogh
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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39
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Cabassa LJ, Stefancic A, Wang X, Guo S, Lu NY, Weatherly C. Correlates of Physical Activity and Cardiorespiratory Fitness in Racially and Ethnically Diverse People with Serious Mental Illness in Supportive Housing. Community Ment Health J 2020; 56:1139-1152. [PMID: 32222849 PMCID: PMC7293576 DOI: 10.1007/s10597-020-00610-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/23/2020] [Indexed: 12/23/2022]
Abstract
We examined demographic, health, and mental health correlates of physical activity and cardiorespiratory fitness (CRF) in racially and ethnically diverse people with serious mental illness (SMI) living in supportive housing. We used baseline data from 314 people with SMI enrolled in a randomized effectiveness trial of a peer-led healthy lifestyle intervention. Sedentary behavior and physical activity were measured with the International Physical Activity Questionnaire. CRF was measured with the 6-min walking test (6MWT). Correlates were identified via ordinary least squares and logistic regressions. Participants were mostly male and racial/ethnic minorities. Thirty-four percent engaged in at least 150-min-per-week of at least moderate-intensity physical activity. On average, participants walked 316.8 m in the 6MWT. Our models show that physical activity and CRF were not evenly distributed in racially and ethnically diverse people with SMI and are associated with multiple demographic, mental health, and health factors. Our findings suggest subgroups and factors that can be targeted to develop health interventions to improve the physical health of people with SMI.
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Affiliation(s)
- Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, 1051 Riverside Dr., Rm 3506, New York, NY, 10031, USA
| | - Xiaoyan Wang
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Shenyang Guo
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Nathaniel Young Lu
- Department of Psychiatry, Columbia University, 1051 Riverside Dr., Rm 3506, New York, NY, 10031, USA
| | - Christopher Weatherly
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
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40
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Daumit GL, Dalcin AT, Dickerson FB, Miller ER, Evins AE, Cather C, Jerome GJ, Young DR, Charleston JB, Gennusa JV, Goldsholl S, Cook C, Heller A, McGinty EE, Crum RM, Appel LJ, Wang NY. Effect of a Comprehensive Cardiovascular Risk Reduction Intervention in Persons With Serious Mental Illness: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e207247. [PMID: 32530472 PMCID: PMC7293000 DOI: 10.1001/jamanetworkopen.2020.7247] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Persons with serious mental illness have a cardiovascular disease mortality rate more than twice that of the overall population. Meaningful cardiovascular risk reduction requires targeted efforts in this population, who often have psychiatric symptoms and cognitive impairment. OBJECTIVE To determine the effectiveness of an 18-month multifaceted intervention incorporating behavioral counseling, care coordination, and care management for overall cardiovascular risk reduction in adults with serious mental illness. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from December 2013 to November 2018 at 4 community mental health outpatient programs in Maryland. The study recruited adults with at least 1 cardiovascular disease risk factor (hypertension, diabetes, dyslipidemia, current tobacco smoking, and/or overweight or obesity) attending the mental health programs. Of 398 participants screened, 269 were randomized to intervention (132 participants) or control (137 participants). Data collection staff were blinded to group assignment. Data were analyzed on the principle of intention to treat, and data analysis was performed from November 2018 to March 2019. INTERVENTIONS A health coach and nurse provided individually tailored cardiovascular disease risk reduction behavioral counseling, collaborated with physicians to implement appropriate risk factor management, and coordinated with mental health staff to encourage attainment of health goals. Programs offered physical activity classes and received consultation on serving healthier meals; intervention and control participants were exposed to these environmental changes. MAIN OUTCOMES AND MEASURES The primary outcome was the change in the risk of cardiovascular disease from the global Framingham Risk Score (FRS), which estimates the 10-year probability of a cardiovascular disease event, from baseline to 18 months, expressed as percentage change for intervention compared with control. RESULTS Of 269 participants randomized (mean [SD] age, 48.8 [11.9] years; 128 men [47.6%]), 159 (59.1%) had a diagnosis of schizophrenia or schizoaffective disorder, 67 (24.9%) had bipolar disorder, and 38 (14.1%) had major depressive disorder. At 18 months, the primary outcome, FRS, was obtained for 256 participants (95.2%). The mean (SD) baseline FRS was 11.5% (11.5%) (median, 8.6%; interquartile range, 3.9%-16.0%) in the intervention group and 12.7% (12.7%) (median, 9.1%; interquartile range, 4.0%-16.7%) in the control group. At 18 months, the mean (SD) FRS was 9.9% (10.2%) (median, 7.7%; interquartile range, 3.1%-12.0%) in the intervention group and 12.3% (12.0%) (median, 9.7%; interquartile range, 4.0%-15.9%) in the control group. Compared with the control group, the intervention group experienced a 12.7% (95% CI, 2.5%-22.9%; P = .02) relative reduction in FRS at 18 months. CONCLUSIONS AND RELEVANCE An 18-month behavioral counseling, care coordination, and care management intervention statistically significantly reduced overall cardiovascular disease risk in adults with serious mental illness. This intervention provides the means to substantially reduce health disparities in this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02127671.
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Affiliation(s)
- Gail L. Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Arlene T. Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Edgar R. Miller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Gerald J. Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Kinesiology, Towson University, Towson, Maryland
| | - Deborah R. Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jeanne B. Charleston
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph V. Gennusa
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Cook
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann Heller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rosa M. Crum
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J. Appel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Guerin E, Dupuis JP, Jacob JD, Prud'homme D. [Physical activity programs and severe mental illness: A case study of an Assertive Community Treatment (ACT) team]. Rech Soins Infirm 2020; 138:29-42. [PMID: 31959239 DOI: 10.3917/rsi.138.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Context : As a therapeutic intervention, physical activity has the potential to improve the quality of life of individuals with severe mental illnesses.Objectives : The goal of this case study was to conduct an in-depth examination of an individualized physical activity program for patients suffering from severe mental illnesses that was implemented by an Assertive Community Treatment (ACT) team in Ottawa, Canada.Method : Using a mixed-methods design, physical health parameters were measured over a nine-month period and semi-structured interviews were conducted with fourteen patients and five staff members.Results : The findings showed a significant reduction in weight following the evaluation period, as well as positive effects in terms of patients' self-esteem, autonomy, and socialization. The quality of the therapeutic relationship, the elimination of barriers, and the continued involvement of staff members were some of the key characteristics that led to the program's success.Discussion/conclusion : These promising results are an indication of the feasibility of this type of intervention among patients with severe mental illnesses as a therapeutic approach to improve their quality of life and support their recovery and social integration.
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42
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Gaughran F, Stahl D, Patel A, Ismail K, Smith S, Greenwood K, Atakan Z, Gardner-Sood P, Stringer D, Hopkins D, Lally J, Forti MD, Stubbs B, Lowe P, Arbuthnott M, Heslin M, David AS, Murray RM. A health promotion intervention to improve lifestyle choices and
health outcomes in people with psychosis: a research programme including the
IMPaCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background
People with psychotic disorders have reduced life expectancy largely because
of physical health problems, especially cardiovascular disease, that are
complicated by the use of tobacco and cannabis.
Objectives
We set out to (1) chart lifestyle and substance use choices and the emergence
of cardiometabolic risk from the earliest presentation with psychosis, (2)
develop a pragmatic health promotion intervention integrated within the
clinical teams to improve the lifestyle choices and health outcomes of
people with psychosis and (3) evaluate the clinical effectiveness and
cost-effectiveness of that health promotion intervention.
Design
We performed a longitudinal cohort study of people presenting with their
first episode of psychosis in three mental health trusts and followed up
participants for 1 year [work package 1, physical health and substance use
measures in first episode of psychosis (PUMP)]. We used an iterative Delphi
methodology to develop and refine a modular health promotion intervention,
improving physical health and reducing substance use in psychosis (IMPaCT)
therapy, which was to be delivered by the patient’s usual care
co-ordinator and used motivational interviewing techniques and
cognitive–behavioural therapy to improve health choices of people
with psychosis (work package 2). We then conducted a multicentre, two-arm,
parallel-cluster, randomised controlled trial to determine the clinical
effectiveness and cost-effectiveness of using the intervention with people
with established psychosis (work package 3: IMPaCT randomised controlled
trial) in five UK mental health trusts. The work took place between 2008 and
2014.
Participants
All people aged between 16 and 65 years within 6 months of their first
presentation with a non-organic psychosis and who were proficient in English
were eligible for inclusion in the PUMP study. Participants in the work
package 2 training development were staff selected from a range of settings,
working with psychosis. Participants in the phase 3 Delphi consensus and
manual development comprised three expert groups of (1)
therapists/researchers recruited from the local and national community, (2)
clinicians and (3) service users, each of whom took part in two iterative
review and feedback sessions. For work package 3, IMPaCT randomised
controlled trial, care co-ordinators in participating community mental
health teams who were permanently employed and had a minimum of four
eligible patients (i.e. aged between 18 and 65 years with a diagnosis of a
psychotic disorder) on their caseload were eligible to participate. In
studies 1 and 3, patient participants were ineligible if they were pregnant
or had a major illness that would have had an impact on their metabolic
status or if they had a significant learning disability. All participants
were included in the study only after giving written confirmed consent.
Main outcome measures
Cardiometabolic risk markers, including rates of obesity and central obesity,
and levels of glycated haemoglobin (HbA1c) and lipids, were the
main outcomes in work package 1 (PUMP), with descriptive data presented on
substance use. Our primary outcome measure for the IMPaCT randomised
controlled trial was the physical or mental health component Short Form
questionnaire-36 items quality-of-life scores at 12 months.
Results
Obesity rates rose from 18% at first presentation with psychosis to 24% by 1
year, but cardiometabolic risk was not associated with baseline lifestyle
and substance use choices. Patterns of increase in the levels of
HbA1c over the year following first presentation showed
variation by ethnic group. We recruited 104 care co-ordinators, of whom 52
(with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with
193 patients) were randomised to deliver treatment as usual, in keeping with
our power calculations. Of these 406 participants with established
psychosis, 318 (78%) and 301 (74%) participants, respectively, attended the
12- and 15-month follow-ups. We found no significant effect of IMPaCT
therapy compared with treatment as usual on the physical or mental health
component Short Form questionnaire-36 items scores at either time point in
an intention-to-treat analysis [physical health score (‘d’)
–0.17 at 12 months and –0.09 at 15 months; mental health score
(‘d’) 0.03 at 12 months and –0.05 at 15 months] or on
costs. Nor did we find an effect on other cardiovascular risk indicators,
including diabetes, except in the case of high-density lipoprotein
cholesterol, which showed a trend for greater benefit with IMPaCT therapy
than with treatment as usual (treatment effect 0.085, 95% confidence
interval 0.007 to 0.16; p = 0.034).
Limitations
Follow-up in work package 1 was challenging, with 127 out of 293 participants
attending; however, there was no difference in cardiometabolic measures or
demographic factors at baseline between those who attended for follow-up and
those who did not. In work package 3, the IMPaCT randomised controlled
trial, care co-ordinators struggled to provide additional time to their
patients that was devoted to the health promotion intervention on top of
their usual clinical care contact with them.
Conclusions
Cardiometabolic risk is prominent even soon after first presentation with
psychosis and increases over time. Lifestyle choices and substance use
habits at first presentation do not predict those who will be most
cardiometabolically compromised 1 year later. Training and supervising care
co-ordinators to deliver a health promotion intervention to their own
patients on top of routine care is not effective in the NHS for improving
quality of life or reducing cardiometabolic risk.
Future work
Further work is needed to develop and evaluate effective, cost-effective and
affordable ways of preventing the emergence of and reversing existing
cardiometabolic risk indicators in people with psychosis.
Trial registration
Current Controlled Trials ISRCTN58667926.
Funding
This project was funded by the National Institute for Health Research (NIHR)
Programme Grants for Applied Research programme and will be published in
full in Programme Grants for Applied Research; Vol. 8, No.
1. See the NIHR Journals Library website for further project
information.
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
- Centre for Primary Care and Public Health, Blizard Institute,
Queen Mary University of London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College London, London, UK
- Forensic Services, South London and Maudsley NHS Foundation
Trust, London, UK
| | - Kathryn Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King’s
Health Partners, London, UK
| | - John Lally
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland,
Beaumont Hospital, Dublin, Ireland
| | - Marta Di Forti
- Social, Genetic & Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Physiotherapy Department, South London and Maudsley NHS
Foundation Trust, London, UK
| | | | | | - Margaret Heslin
- King’s Health Economics, Health Service & Population
Research Department, Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, London, UK
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, University
College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
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Korman N, Fox H, Skinner T, Dodd C, Suetani S, Chapman J, Parker S, Dark F, Collins C, Rosenbaum S, Siskind D. Feasibility and Acceptability of a Student-Led Lifestyle (Diet and Exercise) Intervention Within a Residential Rehabilitation Setting for People With Severe Mental Illness, GO HEART (Group Occupation, Health, Exercise And Rehabilitation Treatment). Front Psychiatry 2020; 11:319. [PMID: 32411024 PMCID: PMC7198865 DOI: 10.3389/fpsyt.2020.00319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE People with severe mental illness (SMI) experience poor physical health and premature mortality, contributed significantly by modifiable lifestyle risk factors such as poor nutrition, low cardiorespiratory fitness, and physical inactivity. Lifestyle interventions can reduce cardiometabolic risk and confer a range of other positive mental and physical health benefits. We assessed the feasibility, acceptability, safety, and preliminary effectiveness of a lifestyle (combined dietary and exercise) intervention lead by senior exercise and dietetics students in a residential mental health rehabilitation setting. DESIGN Single arm, prospective study evaluating outcomes pre and post a 10-week dietary and exercise intervention. METHOD People with SMI from three residential rehabilitation units participated in a mixed aerobic and resistance training exercise intervention three times per week that was combined with a dietary intervention (six individual and group sessions). Primary outcome considerations were feasibility (recruitment, retention, and participation rates), acceptability, and adverse events. Secondary outcomes were preliminary effectiveness; (functional exercise capacity, volume of exercise, and metabolic markers), psychiatric symptoms, quality of life, and attitudes to exercise. RESULTS Forty-two participants were recruited (92% primary diagnosis of schizophrenia). Intervention feasibility was supported by high levels of recruitment (68%), retention (77%), and participation (70% exercise, 65% diet sessions); and the absence of serious adverse events. Significant improvements in functional exercise capacity, volume of exercise, general psychiatric symptoms, and negative psychotic symptoms occurred. Anthropometric and metabolic blood markers did not change. While the intervention was acceptable to participants, motivation for and perceived value of exercise reduced over 10 weeks. CONCLUSIONS A brief pragmatic student-led lifestyle intervention integrated into usual mental health care was feasible, acceptable, safe, and scalable across two additional mental health residential rehabilitation sites, and resulted in physical and mental health improvements. Increased frequency of dietary sessions and length of dietary intervention may improve metabolic outcomes in the future. People with SMI living in residential rehabilitation units should have access to lifestyle programs to address modifiable lifestyle risk factors. While this brief intervention was feasible and acceptable, this study highlights some of the challenges associated with maintaining motivation for healthy lifestyles for people with SMI. Longer term investigation of real-world lifestyle interventions is warranted, together with additional interventions that may support people with SMI to sustain motivation to address lifestyle factors. CLINICAL TRIAL REGISTRATION The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN)-U1111-1211-4009.
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Affiliation(s)
- Nicole Korman
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Harley Fox
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Tina Skinner
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Cassandra Dodd
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Shuichi Suetani
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Justin Chapman
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,Queensland Institute of Medical Research, Mental Health and Complex Disorders, Brisbane, QLD, Australia
| | - Stephen Parker
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Frances Dark
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Cheryl Collins
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Dan Siskind
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
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Incorporating a Physical Activity Program into an Assertive Community Treatment Team: Impact and Strategies. Community Ment Health J 2019; 55:1293-1297. [PMID: 31290032 DOI: 10.1007/s10597-019-00440-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 07/01/2019] [Indexed: 01/28/2023]
Abstract
The objective of this brief report is to present an overview of the main benefits and key characteristics of an individualized physical activity program delivered by an assertive community treatment team in Ottawa, Canada. A mixed-method case study was conducted over a 9-month period. Findings revealed significant reductions in weight, BMI and waist circumference (p < .05) and improvements in self-esteem, autonomy, socialization and other health behaviors. Key characteristics of the program included building a relationship of trust with clients and deploying active efforts to eliminate barriers to PA engagement. Results offer preliminary evidence for integrating an individualized PA program into the ACT team model.
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Bianco CL, Pratt SI, Ferron JC. Deficits in Sexual Interest Among Adults With Schizophrenia: Another Look at an Old Problem. Psychiatr Serv 2019; 70:1000-1005. [PMID: 31401908 DOI: 10.1176/appi.ps.201800403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite the important impact of sexuality on quality of life in adults, there is a paucity of research on this topic for people with schizophrenia. This study examined predictors of sexual interest among adults with schizophrenia. METHODS Using data from three studies with similar measures and participants with similar characteristics (N=231), the authors conducted a secondary analysis to examine the relationships among sexual interest, demographic characteristics (gender, age, living situation, and marital status), and clinical factors (sexual self-efficacy, symptom severity, and medications). Sexual interest was measured by using one item from the Scale to Assess Negative Symptoms. Binomial logistic regressions were conducted to explore factors most associated with level of sexual interest. RESULTS Separately, cardiovascular medications, gender, age, sexual self-efficacy, and negative symptoms were associated with sexual interest. In a logistic regression model that included all of these factors, only sexual self-efficacy and gender were significantly associated with sexual interest. Higher levels of sexual self-efficacy were associated with lower levels of impairment in sexual interest (odds ratio [OR]=0.98, 95% confidence interval [CI]=0.98-0.99, p<0.001), and males were less likely than females to have impaired sexual interest (OR=0.38, 95% CI=0.20-0.73, p=0.004). CONCLUSIONS The strength of the relationship between sexual self-efficacy and sexual interest warrants development of interventions to address sexuality among people with serious mental illness, at least for those who are interested in developing or maintaining intimate relationships. An intervention that teaches skills needed to successfully pursue and navigate intimate relationships could positively influence overall quality of life for many.
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Affiliation(s)
- Cynthia L Bianco
- Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, New Hampshire, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Sarah I Pratt
- Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, New Hampshire, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joelle C Ferron
- Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, New Hampshire, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Dolor RJ, Proctor E, Stevens KR, Boone LR, Meissner P, Baldwin LM. Dissemination and implementation science activities across the Clinical Translational Science Award (CTSA) Consortium: Report from a survey of CTSA leaders. J Clin Transl Sci 2019; 4:188-194. [PMID: 32695487 PMCID: PMC7348014 DOI: 10.1017/cts.2019.422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Dissemination and implementation (D&I) science is not a formal element of the Clinical Translational Science Award (CTSA) Program, and D&I science activities across the CTSA Consortium are largely unknown. METHODS The CTSA Dissemination, Implementation, and Knowledge Translation Working Group surveyed CTSA leaders to explore D&I science-related activities, barriers, and needed supports, then conducted univariate and qualitative analyses of the data. RESULTS Out of 67 CTSA leaders, 55.2% responded. CTSAs reported directly funding D&I programs (54.1%), training (51.4%), and projects (59.5%). Indirect support (e.g., promoted by CTSA without direct funding) for D&I activities was higher - programs (70.3%), training (64.9%), and projects (54.1%). Top barriers included funding (39.4%), limited D&I science faculty (30.3%), and lack of D&I science understanding (27.3%). Respondents (63.4%) noted the importance of D&I training and recommended coordination of D&I activities across CTSAs hubs (33.3%). CONCLUSION These findings should guide CTSA leadership in efforts to raise awareness and advance the role of D&I science in improving population health.
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Affiliation(s)
- Rowena J. Dolor
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Enola Proctor
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Kathleen R. Stevens
- School of Nursing, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Leslie R. Boone
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul Meissner
- Office of the Medical Director for Research, Montefiore Medical Center/Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine and Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
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Aschbrenner KA, Pratt SI, Bond GR, Zubkoff L, Naslund JA, Jue K, Williams G, Kinney A, Cohen MJ, Godfrey MM, Bartels SJ. A virtual learning collaborative to implement health promotion in routine mental health settings: Protocol for a cluster randomized trial. Contemp Clin Trials 2019; 84:105816. [PMID: 31344520 PMCID: PMC10047804 DOI: 10.1016/j.cct.2019.105816] [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: 04/09/2019] [Revised: 07/15/2019] [Accepted: 07/21/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite widespread use of learning collaboratives in health care, few randomized trials have evaluated their effectiveness. The primary aim of this cluster randomized implementation trial is to evaluate the effectiveness of a virtual learning collaborative (VLC) in the implementation of a lifestyle intervention for persons with serious mental illness (SMI) in routine mental health settings, compared to standard individual technical assistance. METHODS Forty-eight mental health provider organizations from across the United States will be recruited to participate in the trial. The evidence-based practice to be implemented is the InSHAPE health promotion intervention for persons with SMI. Sites will be stratified by size and randomized to receive an 18-month intensive group-based VLC with monthly learning sessions or individual technical assistance with four scheduled conference calls over 18 months. Sites will be enrolled in three blocks of 16 sites each. The primary outcomes are InSHAPE program participation and fidelity, and participant weight loss; secondary outcomes are program operation, program uptake, participant health behaviors of physical activity and nutrition, organizational change, and program sustainment. Implementation outcomes are measured at 3, 6, 12, 18, and 24 months after the program start-up. Participant-level outcomes are measured at fixed intervals every 3 months after each participant enrolls in the study. DISCUSSION This study will determine whether VLCs are an effective implementation strategy among resource-limited providers when the new practice necessitates a shift in mission, scope of practice, type of services delivered, and new financing. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03891368 Registered 25 March 2019, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03891368?term=NCT03891368&rank=1.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America.
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America.
| | - Gary R Bond
- Westat, Lebanon, NH, United States of America.
| | - Lisa Zubkoff
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America; White River Junction VAMC, White River Junction, VT, United States of America.
| | - John A Naslund
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, United States of America.
| | - Kenneth Jue
- Ken Jue Consulting, Keene, NH, United States of America.
| | - Gail Williams
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America.
| | - Allison Kinney
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America.
| | - Michael J Cohen
- MJC Health Solutions, Amherst, NH, United States of America.
| | - Marjorie M Godfrey
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America.
| | - Stephen J Bartels
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States of America; The Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America.
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Increasing physical activity and healthy diet in outpatients with mental disorders: a randomized-controlled evaluation of two psychological interventions. Eur Arch Psychiatry Clin Neurosci 2019; 269:529-542. [PMID: 30194668 DOI: 10.1007/s00406-018-0941-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/30/2018] [Indexed: 01/24/2023]
Abstract
INTRODUCTION While physical activity (PA) can play an important role in the treatment of mental disorders (MD), large proportions of patients with MD do not meet PA recommendations. The aim of this trial was to evaluate whether structured psychological intervention (MoVo-LISA) is effective in helping outpatients with MD to increase their level of PA. As active control group (CG) we modified MoVo-LISA to target healthy diet behavior. METHODS N = 83 outpatients with MD (F1-F4) were randomized to the two conditions. PA (self-report and accelerometry), dietary behavior, social-cognitive determinants of health behavior change, psychiatric symptoms and health-related quality of life were assessed at baseline, 1 and 12 weeks after the intervention. RESULTS Significant time*group interaction effects for objectively measured PA, dietary behavior and fruit and vegetable consumption indicated differential effects of the interventions on these outcomes. PA increased in the MoVo-LISA group (IG) from baseline to follow-up while it decreased in CG. IG showed a significant higher level of objectively measured PA at follow-up compared to CG. Dietary behavior and fruit and vegetable consumption significantly increased from baseline to follow-up in CG, but not IG. IG showed a significant increase in some, but not all social cognitive determinants of health behavior change. CONCLUSIONS MoVo-LISA is effective in helping outpatients with MD to increase their level of PA in short- and mid-term. The used intervention strategies are effective for the promotion of healthy diet in patients with MD as well.
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Leppin AL, Mahoney JE, Stevens KR, Bartels SJ, Baldwin LM, Dolor RJ, Proctor EK, Scholl L, Moore JB, Baumann AA, Rohweder CL, Luby J, Meissner P. Situating dissemination and implementation sciences within and across the translational research spectrum. J Clin Transl Sci 2019; 4:152-158. [PMID: 32695482 PMCID: PMC7348034 DOI: 10.1017/cts.2019.392] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022] Open
Abstract
The efficient and effective movement of research into practice is acknowledged as crucial to improving population health and assuring return on investment in healthcare research. The National Center for Advancing Translational Science which sponsors Clinical and Translational Science Awards (CTSA) recognizes that dissemination and implementation (D&I) sciences have matured over the last 15 years and are central to its goals to shift academic health institutions to better align with this reality. In 2016, the CTSA Collaboration and Engagement Domain Task Force chartered a D&I Science Workgroup to explore the role of D&I sciences across the translational research spectrum. This special communication discusses the conceptual distinctions and purposes of dissemination, implementation, and translational sciences. We propose an integrated framework and provide real-world examples for articulating the role of D&I sciences within and across all of the translational research spectrum. The framework's major proposition is that it situates D&I sciences as targeted "sub-sciences" of translational science to be used by CTSAs, and others, to identify and investigate coherent strategies for more routinely and proactively accelerating research translation. The framework highlights the importance of D&I thought leaders in extending D&I principles to all research stages.
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Affiliation(s)
- Aaron L. Leppin
- Department of Health Sciences Research, Mayo Clinic, Mayo Clinic Center for Clinical and Translational Science, Rochester, MN, USA
| | - Jane E. Mahoney
- Division of Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kathleen R. Stevens
- Department of Nursing, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA
| | | | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | | | - Enola K. Proctor
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda Scholl
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA
| | - Justin B. Moore
- Department of Family and Community Medicine, Wake Forest University, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ana A. Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Catherine L. Rohweder
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Paul Meissner
- Department of Family and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Aschbrenner KA, Naslund JA, Tomlinson EF, Kinney A, Pratt SI, Brunette MF. Adolescents' Use of Digital Technologies and Preferences for Mobile Health Coaching in Public Mental Health Settings. Front Public Health 2019; 7:178. [PMID: 31312629 PMCID: PMC6614191 DOI: 10.3389/fpubh.2019.00178] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/13/2019] [Indexed: 11/21/2022] Open
Abstract
Objective: Youth with mental illnesses often engage in unhealthy behaviors associated with early mortality from physical diseases in adulthood, but interventions to support positive health behaviors are rarely offered as part of routine mental health care for this group. Digital health technology that is desirable, accessible, and affordable has the potential to address health behaviors in public mental health settings where many adolescents with severe mental health problems receive care. The aims of this study were to examine how adolescents receiving public mental health services use digital technology and social media and to explore their preferences using technology to support health and wellness. Methods: Using a convergent parallel mixed methods design, we surveyed adolescents ages 13–18 from four community mental health centers in one state and conducted focus group interviews to explore their perspectives on using digital technology and social media to receive health coaching and connect with peers to support healthy behaviors. The survey and focus group data were merged to inform the future development of a digital health intervention for adolescents receiving public mental health services. Results: Of 121 survey respondents (mean age 15.2, SD = 1.5), 92% had a cell phone, 79% had a smartphone, 90% used text messaging, and 98% used social media. Focus group interviews revealed that adolescents were interested in receiving strengths-based mobile health coaching, and they preferred structured online peer-to-peer interactions in which a professional moderator promotes positive connections and adherence to privacy guidelines. Conclusions: Adolescents receiving public mental health services in this study had access to smartphones and were frequent social media users. These data suggest that digital health interventions to promote health and wellness among adolescents may be scalable in community mental health settings. Adolescent participants suggested that digital health interventions for this group should focus on strengths and online peer support for health promotion should include a professional moderator to foster and manage peer-to-peer interactions.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Dartmouth-Hitchcock Clinic, Merrimack, NH, United States
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Allison Kinney
- Dartmouth-Hitchcock Clinic, Merrimack, NH, United States
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Dartmouth-Hitchcock Clinic, Merrimack, NH, United States
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Dartmouth-Hitchcock Clinic, Merrimack, NH, United States
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