Assessing overweight and obesity across mental disorders: personality disorders at high risk

Purpose

The aim of the present investigation is to assess the prevalence of obesity in people diagnosed as having a mental illness and to investigate differences between disorders. This adds to the paucity of research in this particular population of people and assists with preventative knowledge to obtain optimum physical health.

Methods

Data were collected for all 508 male and female inpatients (new and already existing) in a public mental health service centre in Western Australia between January and December 2008. Current weight for all patients and weight gain for some patients were calculated to obtain a body mass index (BMI) value, and diagnostic information was aligned to one of the six major categories of mental illness.

Results

The percentage of obese inpatients (30.3 %) was much higher than that of the general population (21.4 %), with females showing a higher propensity toward obesity than males. Most diagnostic categories had a mean BMI in the overweight range, whereas Personality Disorders had a mean BMI in the obese range (30.07). A gradual increase in weight over a 9-month time period can be seen in most patients who were assessed on more than one occasion.

Conclusions

The proportion of obese people within the mental health system far exceeds that of the general population, with these people at a much greater risk of becoming obese. The highest level of obesity was found in people with a personality disorder rather than in people with psychosis. Further research is needed to ease out the mitigating factors behind weight gain occurring across disorders.     

The Effects of Parental Illness and Other Ill Family Members on the Adjustment of Children

Background

This study addresses limitations of prior research that have used group comparison designs to test the effects of parental illness on youth.

Purpose

This study examined differences in adjustment between children of a parent with illness and peers from ‘healthy’ families controlling for the effects of whether a parent or non-parent family member is ill, illness type, demographics and caregiving.

Methods

Based on questionnaire data, groups were derived from a community sample of 2,474 youth (‘healthy’ family, n?=?1768; parental illness, n?=?336; other family member illness, n?=?254; both parental and other family illness, n?=?116).

Results

The presence of any family member with an illness is associated with greater risk of mental health difficulties for youth relative to peers from healthy families. This risk is elevated if the ill family member is a parent and has mental illness or substance misuse.

Conclusions

Serious health problems within a household adversely impact youth adjustment.     

Food insufficiency is associated with psychiatric morbidity in a nationally representative study of mental illness among food insecure Canadians

Purpose

Studies suggest that people who are food insecure are more likely to experience mental illness. However, little is known about which aspects of food insecurity place individuals most at risk of mental illness. The purpose of this study was to establish the prevalence of mental illness among food insecure Canadians, and examine whether mental illness differs between those who are consuming insufficient amounts of food versus poor quality foods.

Methods

This analysis utilized the publically available dataset from the Canadian Community Health Survey cycle 4.1. Bivariable and multivariable logistic regression were used to examine the associations between food insecurity and mental health disorder diagnosis, while adjusting for potential confounders. Stratified analyses were used to identify vulnerable sub-groups.

Results

Among 5,588 Canadian adults (18–64 years) reporting food insecurity, 58 % reported poor food quality and 42 % reported food insufficiency. The prevalence of mental health diagnosis was 24 % among participants with poor food quality, and 35 % among individuals who were food insufficient (hunger). After adjusting for confounders, adults experiencing food insufficiency had 1.69 adjusted-odds [95 % confidence interval (CI): 1.49–1.91] of having a mental health diagnosis. Stratified analyses revealed increased odds among women (a-OR 1.89, 95 % CI 1.62–2.20), single parent households (a-OR 2.05, 95 % CI 1.51–2.78), and non-immigrants (a-OR 1.88, 95 % CI 1.64–2.16).

Conclusion

The prevalence of mental illness is alarmingly high in this population-based sample of food insecure Canadians. These findings suggest that government and community-based programming aimed at strengthening food security should integrate supports for mental illness in this population.     

Ethnic inequalities in the use of health services for common mental disorders in England

Purpose

The purpose of this study is to investigate whether minority ethnic people were less likely to receive treatment for mental health problems than the white population were, controlling for symptom severity.

Method

We analysed data from 23,917 participants in the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. Survey response rates were 79, 69 and 57 %, respectively. The revised Clinical Interview Schedule was used to adjust for symptom severity.

Results

Black people were less likely to be taking antidepressants than their white counterparts were (Odds ratio 0.4; 95 % confidence interval 0.2–0.9) after controlling for symptom severity. After controlling for symptom severity and socioeconomic status, people from black (0.7; 0.5–0.97) and South Asian (0.5; 0.3–0.8) ethnic groups were less likely to have contacted a GP about their mental health in the last year.

Conclusions

Interventions to reduce these inequalities are needed to ensure that NHS health care is delivered fairly according to need to all ethnic groups.     

The Clustering of Health Behaviours in Older Australians and its Association with Physical and Psychological Status,and Sociodemographic Indicators

Background

Increasing life expectancies, burgeoning healthcare costs and an emphasis on the management of multiple health-risk behaviours point to a need to delineate health lifestyles in older adults.

Purpose

The aims of this study were to delineate health lifestyles of a cohort of older adults and to examine the association of these lifestyles with biological and psychological states and socio-economic indices.

Methods

Cluster analysis was applied to data derived from the self-reported 45 and Up cohort study (N?=?96,276) of Australians over 45 years, regarding exercise, smoking, alcohol consumption, diet and cancer screening behaviours.

Results

Six lifestyle clusters emerged delineated by smoking, screening and physical activity levels. Individuals within health-risk dominant clusters were more likely to be male, living alone, low-income earners, living in a deprived neighbourhood, psychologically distressed and experiencing low quality of life.

Conclusions

Health lifestyle cluster membership can be used to identify older adults at greatest risk for physical and psychological health morbidity.     

Country of birth and hospital treatment for psychosis in New South Wales

Background

Migration has been found to be a risk factor for schizophrenia in several high-income countries.

Aim

To examine whether overseas migrants to New South Wales (NSW) have higher rates of admission to psychiatric hospitals for psychotic disorders, including schizophrenia and mania, compared to people born in Australia.

Methods

The country of birth of people admitted to public mental health units for the treatment of psychotic illness and for non-psychotic disorders between 2001 and 2010 was compared to the country of birth for the NSW population in the 2006 census. Meta-analysis was used to estimate the odds of being admitted for any psychotic disorder, for a schizophrenia-related psychosis and for mania compared to non-psychotic disorder, for those born in Australia, New Zealand and for nine global regions.

Results

Those born in Oceania (including Melanesia, Fiji, Samoa, Tonga and other Polynesian islands, but excluding Hawaii and New Zealand) had the highest odds of admission for the treatment of psychosis compared to a non-psychotic disorder and had the highest odds of being admitted with a diagnosis of schizophrenia or mania.

Conclusions

In the years 2001–2010, those born in Oceania were at an increased risk of admission to NSW psychiatric hospitals for the treatment of psychotic illness.     

Social distance in Lithuanian psychology and social work students and professionals

Purpose

This cross-sectional study aimed to compare desire for social distance from people with mental illness in the disciplines of social work and psychology, and among students and professionals having different professional experience.

Methods

948 respondents (715 students and 233 professionals) from Lithuanian educational and mental health-care institutions participated in an anonymous survey. Social distance was measured using Lithuanian Social Distance Scale which was created for this study. Participants also answered questions about familiarity with mental illness. Bias of social desirability was measured using the balanced inventory of desirable responding.

Results

Series of ANCOVA analysis revealed that psychology and social work master’s and PhD students reported less social distance from people with mental illness when compared with bachelor’s students. Familiarity with mental illness was significantly related to less social distance in the student sample, but not in professionals’ sample. The strongest desire for social distance in the professionals’ sample was observed in social workers having less than 5 years of professional practice and most experienced psychologists with more than 10 years of professional practice.

Conclusions

Social distance from people with mental illness decreases through the study years; however, results of professional psychologists and social workers illustrate different trajectories in social distance through the professional career. The results of this study support the need for anti-stigma programmes and initiatives orientated towards mental health professionals.

     

The utility of outpatient commitment: acute medical care access and protecting health

Objectives

This study considers whether, in an easy access single-payer health care system, patients placed on outpatient commitment—community treatment orders (CTOs) in Victoria Australia—are more likely to access acute medical care addressing physical illness than voluntary patients with and without severe mental illness.

Method

For years 2000 to 2010, the study compared acute medical care access of 27,585  severely mentally ill psychiatrically hospitalized patients (11,424 with and 16,161 without CTO exposure) and 12,229 never psychiatrically hospitalized outpatients (individuals with less morbidity risk as they were not considered to have severe mental illness). Logistic regression was used to determine the influence of the CTO on the likelihood of receiving a diagnosis of physical illness requiring acute care.

Results

Validating their shared and elevated morbidity risk, 53% of each hospitalized cohort accessed acute care compared to 32% of outpatients during the decade. While not under mental health system supervision, however, the likelihood that a CTO patient would receive a physical illness diagnosis was 31% lower than for non-CTO patients, and no different from lower morbidity-risk outpatients without severe mental illness. While, under mental health system supervision, the likelihood that CTO patients would receive a physical illness diagnosis was 40% greater than non-CTO patients and 5.02 times more likely than outpatients were. Each CTO episode was associated with a 4.6% increase in the likelihood of a member of the CTO group receiving a diagnosis.

Conclusion

Mental health system involvement and CTO supervision appeared to facilitate access to physical health care in acute care settings for patients with severe mental illness, a group that has, in the past, been subject to excess morbidity and mortality.

     

A mental health training program for community health workers in India: impact on knowledge and attitudes

Background

Unmet needs for mental health treatment in low income countries are pervasive. If mental health is to be effectively integrated into primary health care in low income countries like India then grass-roots workers need to acquire relevant knowledge and skills to be able to recognise, refer and support people experiencing mental disorders in their own communities. This study aims to provide a mental health training intervention to community health workers in Bangalore Rural District, Karnataka, India, and to evaluate the impact of this training on mental health literacy.

Methods

A pre-test post-test study design was undertaken with assessment of mental health literacy at three time points; baseline, completion of the training, and three month follow-up. Mental health literacy was assessed using the interviewer-administered Mental Health Literacy Survey. The training intervention was a four day course based on a facilitator's manual developed specifically for community health workers in India.

Results

70 community health workers from Doddaballapur, Bangalore Rural District were recuited for the study. The training course improved participants' ability to recognize a mental disorder in a vignette, and reduced participants' faith in unhelpful and potentially harmful pharmacological interventions. There was evidence of a minor reduction in stigmatizing attitudes, and it was unclear if the training resulted in a change in participants' faith in recovery following treatment.

Conclusion

The findings from this study indicate that the training course demonstrated potential to be an effective way to improve some aspects of mental health literacy, and highlights strategies for strengthening the training course.     

Understanding reduced activity in psychosis: the roles of stigma and illness appraisals

Purpose

Increasing activity and social inclusion for people with psychosis is a primary goal of mental health services. Understanding the psychological mechanisms underlying reduced activity will inform more carefully targeted and effective interventions. Anxiety, depression, positive symptom distress and negative symptoms all make a contribution, but much of the variance in activity remains unaccounted for and is poorly understood. Appraisals of illness impact on adjustment to illness: mood, engagement in treatment and quality of life are all affected. It is plausible that illness appraisals will also influence activity. This study investigated the extent to which three components of illness appraisal accounted for variance in activity.

Method

50 people with psychosis completed measures of activity, positive and negative symptoms, anxiety and depression, cognitive functioning, stigma, insight and illness perceptions.

Results

Multiple regression revealed that internalised stigma, but not insight or illness perception, was significantly correlated with reduced activity. 42% of the variance in activity was accounted for by stigma, negative symptoms, positive symptom distress and social support. Affect, cognitive functioning and positive symptoms were not associated with activity.

Conclusion

For people with psychosis, activity levels appear to be compromised particularly by fears of what others think of them and how they will be treated by others. Directly targeting these fears should improve the impact of psychological interventions on functioning. Specific, individualised cognitive behavioural interventions could be a useful adjunct to recovery-focused narrative therapies and complement public information campaigns to reduce discriminatory attitudes and behaviours.     

Another time point,a different story: one year effects of a social media intervention on the attitudes of young people towards mental health issues

Purpose

This study extends an evaluation of a brief, social media intervention, called In One Voice, for raising mental health awareness and improving attitudes of youth and young adults towards mental health issues.

Methods

A successive independent samples design assessed market penetration and attitudinal changes among the young people who completed an online questionnaire 1 year after (T3: n = 438) the intervention. This is compared with two samples that completed a survey either immediately before (T1: n = 403) or 2 months after (T2: n = 403) the campaign launch.

Results

The proportion of respondents who remembered the campaign grew from 24.8 % at T2 to 48.6 % at T3. Elevated website activity on mindcheck.ca was sustained 1 year after In One Voice had ended. Small but significant reductions in personal stigma and social distance were detected from T1 and T3, which were not observed at T2. Respondents’ self-rated ability to help others with mental health issues and to engage in positive behaviors relating to mental health issues (e.g., seeking information) did not improve significantly from T1 to T3.

Conclusions

Improved attitudes towards mental health issues were observed among young people 1 year following a brief social media campaign. The campaign was less effective at providing the tools young people need to feel capable of helping someone who may be experiencing mental health issues, and motivating them to engage in constructive behaviors related to mental health.     

The effects of parent–child relationships on later life mental health status in two national birth cohorts

Purpose

Abusive and neglectful parenting is an established determinant of adult mental illness, but longitudinal studies of the impact of less severe problems with parenting have yielded inconsistent findings. In the face of growing interest in mental health promotion, it is important to establish the impact of this potentially remediable risk factor.

Methods

Participants: 8,405 participants in the 1958 UK birth cohort study, and 5,058 in the 1970 birth cohort study Exposures: questionnaires relating to the quality of relationships with parents completed at age 16?years. Outcomes: 12-item General Health Questionnaire and the Malaise Inventory collected at age 42?years (1958 cohort) and 30?years (1970 cohort). Statistical methodology: logistic regression analyses adjusting for sex, social class and teenage mental health problems.

Results

1958 cohort: relationships with both mother and father predicted mental health problems in adulthood; increasingly poor relationships were associated with increasing mental health problems at age 42?years. 1970 cohort: positive items derived from the Parental Bonding Instrument predicted reduced risk of mental health problems; negative aspects predicted increased risk at age 30?years. Odds of mental health problems were increased between 20 and 80% in fully adjusted models.

Conclusions

Results support the hypothesis that problems with parent–child relationships that fall short of abuse and neglect play a part in determining adult mental health and suggest that interventions to support parenting now being implemented in many parts of the Western world may reduce the prevalence of mental illness in adulthood.     

In the shadow of a new smoke free policy: A discourse analysis of health care providers' engagement in tobacco control in community mental health

Background

The prevalence of tobacco use among individuals with mental illness remains a serious public health concern. Tobacco control has received little attention in community mental health despite the fact that many individuals with mental illness are heavy smokers and experience undue tobacco-related health consequences.

Methods

This qualitative study used methods of discourse analysis to examine the perceptions of health care providers, both professionals and paraprofessionals, in relation to their roles in tobacco control in the community mental health system. Tobacco control is best conceptualised as a suite of policies and practices directed at supporting smoke free premises, smoking cessation counselling and limiting access to tobacco products. The study took place following the establishment of a new policy that restricted tobacco smoking inside all mental health facilities and on their grounds. Ninety one health care providers participated in open-ended interviews in which they described their role in tobacco control. The interview data were analyzed discursively by asking questions such as: what assumptions underlie what is being said about tobacco?

Results

Five separate yet overlapping discursive frames were identified in which providers described their roles. Managing a smoke free environment emphasised the need to police and monitor the smoke free environment. Tobacco is therapeutic was a discourse that underscored the putative value of smoking for clients. Tobacco use is an individual choice located the decision to smoke with individual clients thereby negating a role in tobacco control for providers. It's someone else's role was a discourse that placed responsibility for tobacco control with others. Finally, the discourse of tobacco control as health promotion located tobacco control in a range of activities that are used to support the health of clients.

Conclusions

This study provides insights into the complex factors that shape tobacco control practices in the mental health field and reinforces the need to see practice change as a matter that extends beyond the individual. The study findings highlight discourses structured by power and powerlessness in environments in which health care providers are both imposing and resisting the smoke free policy.     

Quality of life is predictive of relapse in schizophrenia

Background

Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment.

Methods

Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment.

Results

Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group.

Conclusion

A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.     

Mental illness and lost income among adult South Africans

Purpose

Little is known regarding the links between mental disorder and lost income in low- and middle-income countries. The purpose of this study was to investigate the association between mental disorder and lost income in the first nationally representative psychiatric epidemiology survey in South Africa.

Methods

A probability sample of South African adults was administered the World Health Organization Composite International Diagnostic Interview schedule to assess the presence of mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, version IV.

Results

The presence of severe depression or anxiety disorders was associated with a significant reduction in earnings in the previous 12 months among both employed and unemployed South African adults (p = 0.0043). In simulations of costs to individuals, the mean estimated lost income associated with severe depression and anxiety disorders was $4,798 per adult per year, after adjustment for age, gender, substance abuse, education, marital status, and household size. Projections of total annual cost to South Africans living with these disorders in lost earnings, extrapolated from the sample, were $3.6 billion. These data indicate either that mental illness has a major economic impact, through the effect of disability and stigma on earnings, or that people in lower income groups are at increased risk of mental illness. The indirect costs of severe depression and anxiety disorders stand in stark contrast with the direct costs of treatment in South Africa, as illustrated by annual government spending on mental health services, amounting to an estimated $59 million for adults.

Conclusions

The findings of this study support the economic argument for investing in mental health care as a means of mitigating indirect costs of mental illness.     

Desire for information of people with severe mental illness

Purpose

To assess (1) the desire of people with severe mental illness for information on their treatment and (2) whether the desire for information is associated with socio-demographic variables, diagnosis, illness duration, therapeutic relationship, needs and symptom severity.

Methods

588 outpatients with severe mental illness were recruited in six European countries (Germany, Denmark, Hungary, Italy, Switzerland, United Kingdom) during the “Clinical decision making and outcome in routine care of people with severe mental illness (CEDAR)” study (ISRCTN75841675). Desire for information was assessed by the Information subscale of the Clinical Decision Making Style Scale. Study participants with high desire for information were compared with those with moderate or low desire for information.

Results

80 % of study participants (n = 462) wanted to receive information on all aspects of their treatment (management, prognosis, alternative options for care). Participants with a high desire for information had less severe symptoms (OR = 0.988, CI = 0.977–1.000) and a better self-rated therapeutic alliance (OR = 1.304, CI = 1.130–1.508) with their clinician.

Conclusions

Most, but not all, people with severe mental illness have a high desire for information. Desire for information is associated with variables, such as therapeutic relationship and symptom severity, which are amenable to change during treatment.