Assessing Life-Space in a Population with Serious Mental Illness

life-space;serious mental illness;SMI;CES-D;BASIS-24;ACHIEVE trial;Epidemiology

Feinstein, Saul Graham

Johns Hopkins University

关键词: life-space;    serious mental illness;    SMI;    CES-D;    BASIS-24;    ACHIEVE trial;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39479/FEINSTEIN-THESIS-2016.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

BACKGROUND AND OBJECTIVE: The Life-Space Assessment (LSA) is a validated tool that quantitatively measures mobility patterns in community dwelling older adults. Decreased life-space in this population is generally a strong indicator of limited physical function. However in a population with serious mental illness (SMI), decreased life-space may be an indicator of other impairments and barriers pertaining to mental, physical and psychosocial health. Measuring life-space in this population offers a novel opportunity that could address these underlying associations. Specific interventions could target ways to improve mobility once the associations are examined. METHODS: A secondary analysis from the ACHIEVE trial was conducted. The trial was a successful behavioural weight-loss intervention that focused on promoting physical activity and healthy eating for persons with SMI. Life-space measurements were measured at baseline, 6-month and 18-month follow-up visits. Four different sub-scales measured life-space: the composite sub-scale, a daily sub-scale and a daily sub-scale for days when a person visited a psychiatric rehabilitation program (PRP) or did not. Measures pertaining to mental, physical and psychosocial health were assessed for their relationship on life-space at baseline and over follow-up. RESULTS: For 198 participants at baseline the mean age was 45.5 (SD=11.0), over 55% had schizophrenia or a schizoaffective disorder, 22% had bipolar disorder, 14% had major depressive disorder, and about 63% of the whole population presented with depressive symptoms based on the CES-D cut-off of 16 points or more. Positive affect was associated with an increase in all four of the LSA sub-scales at baseline while somatic symptoms were associated with a decrease in the daily sub-scale. Over time, decreasing life-space was associated with depressed affect and fewer activities with neighbors for days in which participants did not go to the PRP, but not for days in which they did. A decreasing life-space composite score and daily score were associated with problems surrounding interpersonal relationships and less social cohesion, respectively.CONCLUSION: The findings of this study suggests that life-space can be used to assess mobility patterns for persons with SMI and that this dimension of health can provide insight into a previously undocumented measure of health. The associations were more pronounced on days that individuals did not visit the PRP, indicating that social isolation could be associated with reduced mobility. The association between decreasing life-space and worse health outcomes that have been established in community dwelling older adults were also observed in this population. Promoting social engagement could increase mobility as well as subsequent health in this population.