Effectiveness of a community‐based nurse‐led lifestyle‐modification intervention for people with serious mental illness and metabolic syndrome

The development of metabolic syndrome negatively affects the quality of life of people with serious mental illness. Experts agree on the need to evaluate the physical health of patients and intervene in modifiable risk factors, with emphasis on the promotion of healthy lifestyles. Interventions should include nutritional counselling and physical activity. This 24‐week randomized trial evaluated the effects of a community‐based nurse‐led lifestyle‐modification intervention in people with serious mental illness meeting metabolic syndrome criteria, and its impact on health‐related quality of life and physical activity. Sixty‐one participants from two community mental health centres were randomly assigned to the intervention or control group. The intervention consisted of weekly group sessions, with 20 min of theoretical content and 60 min of nurse‐led physical activity. Postintervention results between groups showed no differences in weight, waist circumference, fasting glucose, and systolic blood pressure. Differences in body mass index, triglyceride concentrations, and diastolic blood pressure were found to be significant (P = 0.010, P = 0.038, and P = 0.017). Participants who performed the intervention reported an increase in physical activity, which did not occur in the control group (P = 0.035), and also reported better health status (P < 0.001). Our intervention showed positive effects reducing participants’ cardiovascular and metabolic risks and improving their physical activity and quality of life. To our knowledge, this is the first clinical trial led and carried out by mental health nurses in community mental health centres which takes into account the effects of a lifestyle intervention on every metabolic syndrome criterion, health‐related quality of life, and physical activity.     

Educational nurse‐led lifestyle intervention for persons with mental illness

Although persons with severe mental illness face an increased risk of mortality and of developing negative health outcomes, research has shown that lifestyle interventions can sufficiently support their health. In response, this study examined a nurse‐led lifestyle intervention developed in cooperation with members of municipal and county councils to gauge its impact on the quality of life, cognitive performance, walking capacity, and body composition of persons with severe mental illness. Lasting 26 weeks and involving 38 persons with severe mental illness, the intervention prioritised two components: the interpersonal relationships of persons with severe mental illness, staff, and group leaders and group education about physical and mental health. Pre–post intervention measurements of quality of life collected with the Manchester Short Assessment of Quality of Life, cognitive performance with the Frontal Systems Behaviour Scale, walking capacity with a 6‐min walk test, and body composition in terms of waist circumference and body mass index were analysed using a nonparametric test Wilcoxon signed‐rank test. Results suggest that the intervention afforded significant improvements in the health‐related variables of quality of life, cognitive performance, walking capacity, and waist circumference for persons with severe mental illness. However, long‐term studies with control groups and that examine parameters related to cardiovascular risk factors are essential to ensure the sustained impact of the intervention.     

Physical activity attitudes and preferences among inpatient adults with mental illness

The life expectancy of adults with mental illness is worse than that of the general population and is largely due to poor physical health status. Physical activity has been consistently recommended for the prevention and management of many chronic physical health conditions and can also have benefits for mental health. This cross sectional study assessed the attitudes towards and preferences for physical activity among inpatient adults with mental illness, and differences by distress and gender. Self‐report questionnaires were completed by 101 patients. Findings indicated that inpatient adults with mental illness are interested in doing physical activity while in hospital, primarily to maintain good physical health and improve emotional wellbeing. Fewer than half of participants agreed that physical activity has benefits for serious mental illness. Participants indicated a preference for walking and physical activity that can be done alone, at a fixed time and with a set routine and format. Major barriers were fatigue and lack of motivation. Females were more likely than males to prefer activities done with others of the same gender (P = 0.001) and at the same level of ability (P < 0.001). There were no significant differences by level of distress. These findings can inform physical activity intervention programming in hospital settings, which may contribute to decreasing the chronic disease burden and improve the psychological wellbeing in adults with mental illness.     

Meeting the needs? Perceived support of a nurse‐led lifestyle programme for young adults with mental illness in a primary health‐care setting

Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle‐related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse‐led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16–25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse‐led programme provides health information‐management strategies that could easily be integrated in a primary health‐care setting.     

Effects of a community‐based intervention on cardio‐metabolic risk and self‐care behaviour in older adults with metabolic syndrome

This pilot study was performed to investigate the effects of a community‐based intervention (CBI) on cardio‐metabolic risk and self‐care behaviour in 92 older adults with metabolic syndrome at public health centres in Suwon, Korea. A prospective, pretest and posttest, controlled, quasi‐experimental design was used. The older adults in the intervention group participated in an 8‐week intensive lifestyle counselling, whereas those in the control group received usual care. The mean (standard deviation) age of the participants was 71.4 (4.43) years ranging from 60 to 84, and 75.0% of the participants were female. The intervention group at 8 weeks showed significant reduction in waist circumference by ?1.35 cm (P < 0.001) and improved self‐care behaviour (+ 5.17 score, P < 0.05) and self‐efficacy (+ 4.84 score, P < 0.001) when compared with the control group. The percentages of those who successfully completed the targeted behavioural modification were 71.7% for exercise and 52.2% for dietary control in the intervention group at 8 weeks. This pilot study provided evidence of the beneficial impact of the CBI for Korean older adults with metabolic syndrome.     

Chinese Health Improvement Profile for people with severe mental illness: A cluster‐randomized,controlled trial

The aim of the present study was to establish the feasibility of conducting a full‐scale trial and to estimate the preliminary effect of a Chinese Health Improvement Profile (CHIP) intervention on self‐reported physical well‐being of people with severe mental illness (SMI). The study used a parallel‐group, open‐label, cluster‐randomized, controlled trial (RCT) design. Twelve community psychiatric nurses (CPN) and their corresponding 137 patients with SMI were randomized into the CHIP or treatment‐as‐usual (TAU) groups. After training, the CPN completed the CHIP at baseline and 12 months, and the findings were used to devise an individualized care plan to promote health behaviour change. Patients were assessed at baseline and 6 and 12 months after starting the intervention. There was an observed positive trend of improvement on the physical component subscale of SF12v2 in the CHIP group compared to the TAU group after 12 months, but the difference did not reach statistical significance (P = 0.138). The mental component subscale showed a similar positive trend (P = 0.077). CHIP participants were more satisfied with their physical health care than TAU patients (P = 0.009), and the CPN were positive about the usefulness/acceptability of the intervention. There were significant within‐group improvements in the total numbers of physical health risks, as indicated by the CHIP items (P = 0.005). The findings suggest that it is feasible to conduct a full‐scale RCT of the CHIP in future. The CHIP is an intervention that can be used within routine CPN practice, and could result in small–modest improvements in the physical well‐being of people with SMI.     

Improving the physical health of people with severe mental illness in a low secure forensic unit: An uncontrolled evaluation study of staff training and physical health care plans

The life expectancy of people with severe mental illnesses is substantially reduced, and monitoring and screening for physical health problems is a key part of addressing this health inequality. Inpatient admission presents a window of opportunity for this health‐care activity. The present study was conducted in a forensic mental health unit in England. A personal physical health plan incorporating clearly‐presented and easily‐understood values and targets for health status in different domains was developed. Alongside this, a brief physical education session was delivered to health‐care staff (n = 63). Printed learning materials and pedometers and paper tape measures were also provided. The impact was evaluated by a single‐group pretest post‐test design; follow‐up measures were 4 months’ post‐intervention. The feasibility and acceptability of personal health plans and associated resources were examined by free‐text questionnaire responses. Fifty‐seven staff provided measures of attitudes and knowledge before training and implementation of the physical health plans. Matched‐pairs analysis indicated a modest but statistically‐significant improvement in staff knowledge scores and attitudes to involvement in physical health care. Qualitative feedback indicated limited uptake of the care plans and perceived need for additional support for better adoption of this initiative. Inpatient admission is a key setting for assessing physical health and promoting improved management of health problems. Staff training and purpose‐designed personalized care plans hold potential to improve practice and outcomes in this area, but further support for such innovations appears necessary for their uptake in inpatient mental health settings.     

Impact of a nurse practitioner role on metabolic monitoring completion and referrals for consumers admitted to the intensive care area of an acute inpatient psychiatric unit

Mental illness increases a person's risk of physical health issues, including cardiovascular disease, leading to premature morbidity and mortality. Screening for cardiovascular disease through metabolic monitoring is recommended to aid in early detection. The aim of the present study was to ascertain whether consumers admitted to an inpatient mental health unit receive routine metabolic monitoring, and to explore the contribution of a nurse practitioner to metabolic monitoring and the actioning of abnormal results. The present study used a retrospective mirror image cohort method to look at clinical consumer files for two separate 6‐month periods before and after a nurse practitioner role commenced. Metabolic monitoring variables were computed as completion frequencies and percentages. Univariate analyses were computed to describe differences among metabolic monitoring variables. A total of 497 consumers were admitted to the mental health inpatient unit's intensive care area across the two 6‐month data‐collection periods. Prior to the nurse practitioner role, only 2% of consumers had their body mass index (BMI) risk calculated; less than 1% had their waist circumference measured, and no abnormal results were referred to a general practitioner (GP). After the nurse practitioner role commenced, BMI risk was calculated for 67% of consumers, waist circumference recorded for 68%, and referrals for abnormal results were forwarded to 37 consumers’ GPs. A nurse practitioner on the inpatient mental health unit has allowed for a considerable increase in the metabolic screening of admitted consumers resulting in a number of referrals being forwarded to consumers’ GPs to be acted upon.     

Mental health nurses’ experience of physical health care and health promotion initiatives for people with severe mental illness

Health care for people with severe mental illness is often divided into physical health care and mental health care despite the importance of a holistic approach to caring for the whole person. Mental health nurses have an important role not only in preventing ill health, but also in promoting health, to improve the overall health among people with severe mental illness and to develop a more person‐centred, integrated physical and mental health care. Thus, the aim of this study was to describe mental health nurses’ experiences of facilitating aspects that promote physical health and support a healthy lifestyle for people with severe mental illness. Interviews were conducted with mental health nurses (n = 15), and a qualitative content analysis was used to capture the nurse’s experiences. Analysis of the interviews generated three categories: (i) to have a health promotion focus in every encounter, (ii) to support with each person’s unique prerequisites in mind and (iii) to take responsibility for health promotion in every level of the organization. The results show the importance of a health promotion focus that permeates the entire organization of mental health care. Shared responsibility for health and health promotion activities should exist at all levels: in the person‐centred care in the relation with the patient, embedded in a joint vision within the working unit, and in decisions at management level.     

Providing physical health care for people accessing mental health services: Clinicians’ perceptions of their role

The prevalence of health risk behaviours and associated poor physical health is high in people with severe mental illness. Mental health service guidelines and policies stipulate that mental health services should address physical health of people who access services. This study reports results from a large, interdisciplinary, cross‐sectional study exploring mental health clinicians’ (n = 385) views of role legitimacy in physical health service provision. All disciplines reported that mental health clinicians have a role to play in addressing the physical health of consumers. Among mental health clinicians, psychiatrists and mental health nurses received higher endorsement than allied health clinicians in relation to the provision of physical health care, with primary care providers including general practitioners also ranking highly. As community mental health services routinely appoint allied health staff to case management roles, a challenge for services and a challenge for clinicians are to ensure that physical health and the effects of medication are monitored appropriately and systematically. Online and telephone support services received relatively lower endorsement. As the availability of nonface to face services increases, there is a need to explore their utility in this population and where appropriate promote their uptake.     

Physical activity using wrist‐worn accelerometers: comparison of dominant and non‐dominant wrist

The purpose of this study was to determine whether there is a difference in physical activity assessment between a wrist‐worn accelerometer at the dominant or non‐dominant arm. The secondary purpose was to assess the concurrent validity of measures of physical activity from the wrist‐worn accelerometer and the waist‐worn accelerometer. Forty adults wore three accelerometers simultaneously, one on the waist and one each on the non‐dominant wrist and dominant wrist, respectively, for 24 consecutive hours of free‐living conditions. Data were uploaded from the monitor to a computer following a 1‐day test period. There were no significant differences in physical activity when comparing the dominant versus the non‐dominant wrist, regardless of axis (P>0·05). Mean daily accelerometer output data from both wrists were strongly correlated with average counts per minute from the ActiGraph worn around the waist (r = 0·88, P<0·001). Findings suggest that the choice to wear the accelerometer on the non‐dominant or dominant wrist has no impact on results. Data from this study contribute to the knowledge of how to best assess physical activity habits.     

Assessment of cardiovascular risk in an Italian psychiatric outpatient sample: A chart review of patients treated with second‐generation antipsychotics

Despite the call by the scientific community for a systematic monitoring of physical health in people with psychiatric illnesses, national and international audits have reported poor quality of cardiovascular risk assessments and management in this vulnerable population. Available evidence indicates that in people affected by mental illness, life expectancy is reduced by 10–20 years, mainly due to cardiovascular accidents and metabolic syndrome (MetS)‐related diseases. The primary aim of the present study was to evaluate the accuracy of cardiovascular risk monitoring in an outpatient sample of patients taking second‐generation antipsychotics. The sample consisted of 200 patients consecutively recruited from two community mental health centres. A clinical chart review was performed on the following laboratory tests: total cholesterol, high‐ and low‐density lipoprotein, serum triglycerides, fasting blood glucose, γ‐glutamyl transpeptidase. Blood pressure and waist circumference were measured. A complete cardiovascular risk assessment was available only in 60 patients out of 200 (33.3%). The only variable associated with laboratory tests for MetS was receiving three or more psychotropic medications, which increased fourfold the probability of metabolic screening. In the subsample of patients with full screening, the prevalence of MetS was 33.3%. Our findings suggest that mental health professionals working in community mental health services should incorporate a more systematic assessment of physical health in their practice, and intervene proactively to reduce the significant cardiovascular burden carried by people with several mental illness.     

Keeping the body in mind: A qualitative analysis of the experiences of people experiencing first‐episode psychosis participating in a lifestyle intervention programme

The life expectancy gap experienced by people living with severe mental illness is primarily a result of cardiometabolic disease that is often exacerbated by side effects of antipsychotic medication. Commencement of atypical antipsychotic medication is commonly associated with weight gain. The Keeping the Body in Mind programme has demonstrated that early intervention with lifestyle activities can attenuate this weight gain and potentially improve long‐term health outcomes. The aim of this study was to explore the experiences of young people who participated in the Keeping the Body in Mind programme, a targeted lifestyle intervention programme. A qualitative approach was used employing a semi‐structured interview format. The interview schedule included questions related to four topics: aspects of the programmes that were useful, attributes of staff members that influenced the programme, changes in attitudes towards their own physical health, and suggestions for programme improvements. Interviews were recorded with duration ranging from 40 to 65 min. Thematic analysis was used to detect and assemble codes. These were then synthesized and classified into themes. Eleven participants were interviewed (seven males), aged between 18 and 25 years. Thematic analysis revealed four main themes: the role of physical health in mental health recovery; the importance of staff interactions; the value of peer interaction; and graduation to a sustainable healthy lifestyle. Study participants reported that they valued the programme for both their physical health and mental health recovery.     

Undergraduate nursing students’ stigma and recovery attitudes during mental health clinical placement: A pre/post‐test survey study

Undergraduate nursing students have been reported to hold negative and stigmatizing attitudes towards mental health consumers and to be under‐prepared for mental health clinical placement. This study aimed to investigate undergraduate nurses’ stigma and recovery attitudes to mental illness, and describe their understandings of personal recovery on entry and exit to traditional mental health clinical placement. A pre/post‐test survey was administered to N = 249 nursing students in Australia. Demographic data, attitudes towards mental health nursing and clinical placement, the Opening Minds Scale for Healthcare Providers (OMS‐HC), Recovery Attitudes Questionnaire (RAQ‐7), and an open‐ended question on understandings of personal recovery from mental illness were collected on entry (T1) and exit (T2) to placement. At T1, students reported moderate stigma and positive attitudes towards recovery (OMS‐HC mean = 34.6; RAQ‐7 mean = 4.0). At T2, there was a reduction in stigma (social distance P = 0.02, d = 0.26) and improvement in recovery attitudes (P < 0.01, d = 0.40). Attitudes towards mental health nursing and placement also improved (P < 0.01). Having a family member with mental illness predicted improvements in stigma and recovery attitudes. On entry to placement, most students described accurate understandings of personal recovery, which were maintained during placement. The findings indicate that mental health clinical placements are effective in improving students’ mental health stigma and recovery attitudes and provide a prime opportunity to attract students into the field. Co‐produced or consumer‐led education provided by peer workers during clinical placements may improve students’ stigmatizing attitudes and stimulate their interest to work in the field.     

Nurse views on the cardiometabolic health nurse as an approach to improving the physical health of people with serious mental illness in Australia

People with serious mental illness (SMI) die prematurely from common physical illnesses such as cardiovascular disease and diabetes. These cardiometabolic risks are preventable and manageable yet these aspects of health care have been neglected in mental health services. A potential nurse‐based strategy to decisively improve cardiometabolic health of people with SMI is to introduce a cardiometabolic health nurse (CHN) into mental health services. The current study aimed to establish the views of nurses working in mental health care on the potential benefits and limits of CHN to improve physical health‐care standards in Australia. All members of the Australian College of Mental Health Nurses were invited to participate in an online survey and 643 participated. Nurses generally agreed that a CHN role would provide a range of improvements to physical health care, such as increased detection, assessment on, and follow up of cardiometabolic risks, and decreased workload for other nurses. While participants were generally supportive of such a role, they felt it would not be suitable in all health‐care settings in Australia.     

Systematic screening for metabolic syndrome in consumers with severe mental illness

The high prevalence of metabolic syndrome (MetS) in people with a mental illness has been reported recently in the literature. Gaps have emerged in the widespread use of systematic screening methods that identify this collection of critical risk factors for cardiac and metabolic disorders in people with severe mental illness. A sample (n = 103) of consumers with severe mental illness was screened for MetS using the Metabolic Syndrome Screening Tool and compared to a sample (n = 72) of consumers who were not receiving a systematic approach to screening for MetS. The results demonstrated ad hoc screening of consumers for MetS in the comparison group, potentially leaving patients at risk of cardiac and metabolic disorders being untreated. Mental health nurses are well placed to show leadership in the screening, treatment, and ongoing management of MetS in people with severe mental illness. A potential new speciality role entitled the ‘cardiometabolic mental health nurse’ is proposed as a means leading to improved outcomes for consumers who have both the complication of physical health problems and a severe mental illness.     

Peer support interventions seeking to improve physical health and lifestyle behaviours among people with serious mental illness: A systematic review

People with serious mental illness (SMI) experience a premature mortality gap of between 10 and 20 years. Interest is growing in the potential for peer support interventions (PSI) to improve the physical health of people with SMI. We conducted a systematic review investigating if PSI can improve the physical health, lifestyle factors, and physical health appointment attendance among people with SMI. A systematic search of major electronic databases was conducted from inception until February 2016 for any article investigating PSI seeking to improve physical health, lifestyle, or physical health appointment attendance. From 1347 initial hits, seven articles were eligible, including three pilot randomized, control trials (interventions: n = 85, controls: n = 81), and four pretest and post‐test studies (n = 54). There was considerable heterogeneity in the type of PSI, and the role of the peer support workers (PSW) varied considerably. Three studies found that PSI resulted in insignificant reductions in weight. Evidence from three studies considering the impact of PSI on lifestyle changes was equivocal, with only one study demonstrating that PSI improved self‐report physical activity and diet. Evidence regarding physical health appointment attendance was also unclear across four studies. In conclusion, there is inconsistent evidence to support the use of PSW to improve the physical health and promote lifestyle change among people with SMI. The small sample sizes, heterogeneity of interventions, outcome measures, and lack of clarity about the unique contribution of PSW means no definitive conclusions can be made about the benefits of PSW and physical health in SMI.     

Effects of the Thai Health Improvement Profile intervention on the physical health and health behaviours of people with schizophrenia: A quasi‐experimental study

Physical health problems and unhealthy lifestyle behaviours are common in people with severe mental illness (SMI), leading to high levels of mortality.There is some evidence that nurse‐led interventions involving comprehensive health checks may be effective in improving physical health in people with SMI. This quasi‐experimental before‐and‐after study investigated the impacts of the Thai Health Improvement Profile (HIP‐T) on the physical health and health behaviours of people with schizophrenia over 1‐year. All 105 service‐users who volunteered to participate completed the study. There were significant reductions in mean BMI (?0.78 kg/m², P < .001) and bodyweight (?1.13 kg, P < .001) at post‐test. There was also a significant decrease in the total number of “red‐flagged” HIP‐T items, suggesting lowered potential health risks (P < .001). Overall, 23 patients (22%) were found to have moved to a healthier BMI classification after 1‐year. The findings suggest that the HIP‐T intervention has potential for improving the physical health of people with SMI when integrated into routine community mental health care.     

Effects of a music‐creation programme on the anxiety,self‐esteem,and quality of life of people with severe mental illness: A quasi‐experimental design

Many studies have shown that music therapy improves patients' symptoms. However, interventions using music creation as their core await further development for patients with severe mental illness (SMI). The current study investigated the effect of a music‐creation programme on the anxiety, self‐esteem, and quality of life of patients with SMI. A quasi‐experimental design using convenience sampling was adopted to recruit patients with SMI from a psychiatric day care centre. Participants were grouped based on their willingness to undergo an intervention (26 patients in the experimental group and 23 patients in the control group). The control groups participated in conventional mental rehabilitation therapy activities. The experimental group participated in a music‐creation session for 90 min every week over a 32‐week period. The outcome indicators before and after the intervention were assessed using the Hamilton Anxiety Rating Scale (HAM‐A), Rosenberg Self‐Esteem Scale (RSES), and World Health Organization Quality of Life‐BREF (WHOQOL‐BREF). Finally, the intervention effect was determined using generalized estimating equations (GEEs). After 32 weeks of intervention activities, the experimental group showed significant improvements in their HAM‐A total scores (P < 0.001) and RSES total scores (P = 0.005). Regarding quality of life, the improvements of the experimental group in terms of the psychological (P = 0.016) and social relationship domains (P = 0.033) were superior to those of the control group. Music‐creation programmes are recommended for inclusion in the routine rehabilitation activities of patients with SMI.