Understanding the problems developing a healthy living programme in patients with serious mental illness: a qualitative study

BMC Psychiatry

Anthony Pelosi¹  John Geddes⁴  Susan Hughes²  Robert Pearsall³ 

[1]Regional Eating Disorders Unit, St John’s Hospital, Livingston, UK

[2]Community Health Clinic, Carluke, UK

[3]Department of Psychiatry, Monklands Hospital, Airdrie, UK

[4]Department of Psychiatry, University of Oxford, Oxford, UK

关键词: Healthy living programme;    Serious mental illness;    Qualitative study;    Physical health;    Healthy living;   

Others  :  1123784
DOI  :  10.1186/1471-244X-14-38

 received in 2013-07-23, accepted in 2014-02-03,  发布年份 2014

【 摘 要 】

Background

People with serious mental illness are at an increased risk of physical ill health. Mortality rates are around twice those of the general population with higher levels of cardiovascular disease, metabolic disease, diabetes, and respiratory illness. Although genetics may have a role in the physical health problems of these patients, lifestyle and environmental factors such as smoking, obesity, poor diet, and low levels of physical activity play a prominent part.

Methods

A qualitative grounded theory approach was used to understand the problems experienced by these individuals when asked to attend a healthy living programme. Three main areas were explored: the influence of potential barriers, health problems, and general attitudes towards healthy living.

Results

Thirteen patients were interviewed during the study. Many did not recall receiving an initial invitation letter to the programme. Several believed that there was no necessity to attend as they had already had recent routine health checks by their general practitioner. The patients’ current level of mental and physical health was important with symptoms such as depression, anxiety or arthritis affecting interest in the programme. Patients described that they found smoking enjoyable or calming in its effect. Dietary intake was determined by taste or gaining pleasure in eating certain types of food. Several lessons were learnt during this research that may aid future research and practice. Participation seemed to be better if the approach was first made by the patient’s own community keyworker. This contact may have provided a greater opportunity to explain the purpose and importance of the programme. Alternative appointments should be considered when certain patients are in better physical and mental health. Healthy living programmes need to be flexible and adaptive to individual patient needs. Assistance from their community worker may help engagement. Simple measures may improve participation and reduce potential barriers.

Conclusion

These findings highlighted some of the problems encountered by patients when attempting to participate in a healthy living programme. These results may be useful when implementing future healthy living interventions for patients with serious mental disorders.

【 授权许可】

   
2014 Pearsall et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]The Schizophrenia Commission: The abandoned illness: a report from the schizophrenia commission. London: Rethink Mental Illness; 2012.
• [2]Roberts L, Roalfe A, Wilson S, Lester H: Physical health care of patients with schizophrenia in primary care: a comparative study. Fam Pract 2007, 24:34-40.
• [3]Saha S, Chant D, McGrath J: A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry 2007, 64(10):1123-1131.
• [4]Brown S: Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry 1997, 171(12):502-508.
• [5]Leucht S, Burkard T, Henderson J, Maj M, Sartorius N: Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 2007, 116:317-333.
• [6]Goff DC, Sullivan LM, McEvoy JP: A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophr Res 2005, 80:45-53.
• [7]De Hert M, Schreurs V, Vancampfort D, Van Winkel R: Metabolic syndrome in people with schizophrenia: a review. World Psychiatry 2009, 8:15-22.
• [8]Newcomer JW, Haupt DW: Abnormalities in glucose regulation during antipsychotic treatment of schizophrenia. Arch Gen Psychiatry 2002, 59:337-345.
• [9]Mukherjee S, Decina P, Bocola V, Saraceni F, Scapicchio PL: Diabetes mellitus in schizophrenic patients. Compr Psychiatry 1996, 37:68-73.
• [10]Filik R, Sipos A, Kehoe PG, Burns T, Cooper SJ: The cardiovascular and respiratory health of people with schizophrenia. Acta Psychiatr Scand 2006, 113:298-305.
• [11]Ryan M, Collins P, Thakore J: Impaired fasting glucose tolerance in first episode, drug-naive patients with schizophrenia. Am J Psychiatry 2003, 160:284-289.
• [12]Tosh G, Clifton A, Mala S, Bachner M: Physical health care monitoring for people with serious mental illness. Cochrane Database Syst Rev 2010., CD008298(1)
• [13]The Scottish, Government: Scottish health survey. Edinburgh: The Scottish Government; 2010. http://www.scotland.gov.uk/publications webcite
• [14]Brown S, Birtwistle J: The unhealthy lifestyle of people with schizophrenia. Psychol Med 1999, 29(3):697-701.
• [15]Green A, Patel J, Goisman R: Weight gain from novel antipsychotics drugs: need for action. Gen Hosp Psychiatry 2000, 22:224-235.
• [16]Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC, Weiden PJ: Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry 1999, 156(11):1686-1696.
• [17]Daumit GL, Goldberg RW, Anthony C, Dickerson F: Physical activity patterns in adults with severe mental illness. J Nerv Ment Dis 2005, 193:641-646.
• [18]Paton C, Esop R, Young C: Obesity, dyslipidaemias, and smoking in an inpatient population treated with antipsychotic drugs. Acta Psychiatr Scand 2004, 110:299-305.
• [19]Muir-Cochrane E: Medical co-morbidity risk factors and barriers to care for people with schizophrenia. J Psychiatr Mental Health Nurs 2006, 13(4):447-452.
• [20]George TP, Vessicchio JC, Sacco KA, Weinberger AH, Dudas MM, Allen TM, Creeden CL, Potenza MN, Feingold A, Jatlow PI: A placebo-controlled trial of bupropion combined with nicotine patch for smoking cessation in schizophrenia. Biol Psychiatry 2008, 63:1092-1096.
• [21]Mauri M, Simoncini M, Castrogiovanni S, Iovieno N, Cecconi D: A psychoeducational programme for weight loss in patients who have experienced weight gain during antipsychotic treatment with olanzapine. Pharmacopsychiatry 2008, 41:17-23.
• [22]Lawn SJ, Pols RG, Barber JG: Smoking and quitting: a qualitative study with community-living psychiatric clients. Soc Sci Med 2002, 54:93-104.
• [23]Pearsall R: Improving healthy living in adults with serious mental illness. DPhil thesis: University of Oxford; 2012.
• [24]Cresswell JW: Qualitative inquiry and research design. Thousand Oaks, London: Sage Publications; 1998.
• [25]NVivo: Qualitative software, version 8.0. http://www.qsrinternational.com webcite
• [26]Scottish Office: Towards a healthier Scotland – A white paper on health. Edinburgh; 1999. http://www.scotland.gov.uk webcite
• [27]Scottish health survey. Edinburgh: The Scottish Government; 2008. http://www.scotland.gov.uk/publications webcite
• [28]Kerr S, Woods C, Knussen C, Watson H, Hunter R: Breaking the habit: a qualitative exploration of barriers and facilitators to smoking cessation in people with enduring mental health problems. BMC Public Health 2013, 13(1):221. BioMed Central Full Text
• [29]McDevitt J, Snyder M, Miller A, Wilbur J: Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation. J Nurs Scholarsh 2006, 38(1):50-55.
• [30]Johnstone R, Nicol K, Donaghy M, Lawrie S: Barriers to update of physical activity in community-based patients with schizophrenia. J Ment Health 2009, 18(6):523-532.
• [31]Miller JB: Hospital admission for schizophrenia and bipolardisorder. Brit Med J 2011, 343:d5652.
• [32]Brunero S: Systematic screening for metabolic syndrome in consumers with severe mental illness. Int J Ment Health Nurs 2009, 18(2):144-150.
• [33]De Hert M, Vancampfort D, Correll CU, Mercken V, Peuskens J, Sweers K, van Winkel R, Mitchell AJ: Guidelines for screening and monitoring of cardiometabolic risk in schizophrenia: systematic evaluation. Br J Psychiatry 2011, 199(2):99-105.