Cigarette smoking behaviors among adults with serious mental illness in a nationally representative sample

PurposeThis study updates nationally representative information on cigarette smoking behaviors among adults with mental illness, particularly serious mental illness (SMI), to serve as a new benchmark for smoking cessation initiatives.MethodsData are from the 2008–2012 National Surveys on Drug Use and Health. Prevalence estimates for past month daily smoking, heavy smoking, mean cigarettes consumed per day, nicotine dependence, past month quit ratio, and proportion of cigarettes consumed are presented by mental illness status.ResultsAdults with SMI were more likely than adults with any mental illness (AMI) but not SMI and adults without mental illness to engage in smoking behaviors. Adults with AMI but not SMI were more likely to engage in all smoking behaviors compared with adults without mental illness. The past month quit ratio was significantly lower among adults with SMI and among adults with AMI but not SMI than among adults without mental illness. Adults with SMI comprised 6.9% of past month smokers but consumed 8.7% of all cigarettes.ConclusionsAdults with mental illness engage in more smoking behaviors and are less likely to quit than adults without mental illness. In this high-risk population, continued efforts to promote smoking cessation are needed.     

The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial

We assessed the effects of the Toronto Site Housing First (HF) intervention on hospitalizations and emergency department (ED) visits among homeless adults with mental illness over 7 years of follow-up. The Toronto Site is part of an unblinded multi-site randomized pragmatic trial of HF for homeless adults with mental illness in Canada, which followed participants up to 7 years. Five hundred seventy-five participants were recruited and classified as having high (HN) or moderate need (MN) for mental health support services. Each group was randomized into intervention (HF) and treatment as usual groups, and 567 (98.6%) consented to link their data to health administrative databases. HF participants received a monthly rent supplement of $600 (Canadian) and assertive community treatment (ACT) support or intensive care management (ICM) support based on need level. Treatment as usual (TAU) participants had access to social, housing, and health services generally available in the community. Outcomes included all-cause and mental health-specific hospitalization, number of days in hospital, and ED visit. We used GEE models to estimate ratio of rate ratios (RRR). The results showed HF with ACT had no significant effect on hospitalization rates among HN participants, but reduced the number of days in hospital (RRR = 0.32, 95% CI 0.16-0.63) and number of ED visits (RRR = 0.57, 95% CI 0.34-0.95). HF with ICM resulted in an increase in the number of hospitalizations (RRR = 1.69, 95% CI 1.09-2.60) and ED visit rates (RRR = 1.42, 95% CI 1.01-2.01) but had no effect in days in hospital for MN participants. Addressing the health needs of this population and reducing acute care utilization remain system priorities. Trial registration: http://www.isrctn.com/identifier: ISRCTN42520374Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-021-00550-1.     

南京市重性精神疾病患者生命质量及影响因素研究

目的 分析重性精神疾病患者生命质量的主要影响因素,为提高其生命质量提供科学依据。方法 采用简明健康调查问卷（the MOS 36-item short form health survey,SF-36）,当面询问调查重性精神疾病患者,共679人纳入分析。结果 重性精神疾病患者生理总分（physical component summary, PCS）、心理总分（mental component summary, MCS）的平均水平分别为（48.64±10.62）分、（37.86±14.66）分。经多元线性模型分析结果显示: 低年龄者、受教育程度高、无伴发躯体疾病、无药物不良反应、社会功能无缺陷者PCS较高（均有P<0.05）;无精神病症状、危险性分级低风险、社会功能无缺陷者MCS较高（均有P<0.05）。结论 重性精神疾病严重损害患者的心理健康,同时对生理健康也有一定程度的损害。在对重性精神疾病患者的干预中,要重点治疗精神病症状、控制危险性、改善社会功能,以提高患者的心理健康。同时,关注患者有无伴发躯体疾病、药物不良反应,并积极缓解,以提高患者生理健康。     

西安市226名老年人心理健康影响因素调查

目的了解西安市老年人心理健康基本情况,探索老年心理健康的危害因素和保护因素,为老年人心理的健康发展提出建议。方法以西安市226名老年人为调查对象,采用中国科学院吴振云等编制的成套中国老年人心理健康问卷进行调查,对该地老年人心理健康水平进行评估。结果老年人的心理健康总分受到性别(P0.05)、受教育程度(P0.01)、生理健康状况(P0.01)、经济水平(P0.01)显著影响,年龄(P=0.073)也对老年心理健康产生一定影响。结论西安市老年人心理健康状态受诸多因素影响。提高国民教育、增强医疗保障、完善养老政策将有利于提高我国老年人心理健康水平。     

Behavioral health home impact on transitional care and readmissions among adults with serious mental illness

ObjectiveTo evaluate the impact of Maryland''s behavioral health homes (BHHs) on receipt of follow‐up care and readmissions following hospitalization among Medicaid enrollees with serious mental illness (SMI).Data SourcesMaryland Medicaid administrative claims for 12 232 individuals.Study DesignWeighted marginal structural models were estimated to account for time‐varying exposure to BHH enrollment and time‐varying confounders. These models compared changes over time in outcomes among BHH and comparison participants. Outcome measures included readmissions and follow‐up care within 7 and 30 days following hospitalization.Data Collection/Extraction MethodsEligibility criteria included continuous enrollment in Medicaid for the first two years of the study period; 21‐64 years; and use of psychiatric rehabilitation services.Principal FindingsOver three years, BHH enrollment was associated with 3.8 percentage point (95% CI: 1.5, 6.1) increased probability of having a mental health follow‐up service within 7 days of discharge from a mental illness–related hospitalization and 1.9 percentage point (95% CI: 0.0, 3.9) increased probability of having a general medical follow‐up within 7 days of discharge from a somatic hospitalization. BHHs had no effect on probability of readmission.ConclusionsBHHs may improve follow‐up care for Medicaid enrollees with SMI, but effects do not translate into reduced risk of readmission.     

The association of birth weight with cardiovascular risk factors and mental problems among Iranian school-aged children: The CASPIAN-III Study

ObjectiveBoth high and low birth weights (HBW and LBW) are risk factors for adulthood diseases. The aim of this study was to investigate the association of birth weight with cardiovascular disease (CVD) risk factors and mental problems among Iranian school-aged children.MethodsThis national multicenter study of school-aged children entitled CASPIAN III was conducted among 5528 students in ranging from ages 10 to 18 y. Biochemical indices and anthropometric measurements were collected. Mental health was assessed by questionnaire. To investigate the association between birth weight categories and CVD risk factors and mental problems, multivariate logistic regression was used.ResultsHBW adolescents were at higher risk for elevated diastolic blood pressure (DBP) (P_trend < 0.05), low levels of high-density lipoprotein cholesterol (HDL-C) (P_trend < 0.05), and lower risk for general obesity (P_trend < 0.05) compared with the LBW category. HBW had no significant association with mental problems (P_trend > 0.05) compared with LBW adolescents. The results of regression analysis, which considered normal birth weight as the reference group, showed that LBW students had lower risk for overweight and obesity (P < 0.01), as well as higher DBP (P < 0.05) but they were at higher risk for lower levels of HDL-C (P < 0.01). Furthermore, birth-weight categories had a U-shaped relationship with mental problems and sleep disorders (P < 0.05). Risk for confusion was higher among the LBW group (P < 0.05).ConclusionFindings from this population-based study revealed a positive relation between birth weight categories and CVD risk factors. Compared with students born with normal weight, those born with HBW and LBW were at higher risk for mental problems, sleep disorders, and confusion.     

Development and Initial Validation of the Observer-Rated Housing Quality Scale (OHQS) in a Multisite Trial of Housing First

Quality of housing has been shown to be related to health outcomes, including mental health and well-being, yet “objective” or observer-rated housing quality is rarely measured in housing intervention research. This may be due to a lack of standardized, reliable, and valid housing quality instruments. The objective of this research was to develop and validate the Observer-Rated Housing Quality Scale (OHQS) for use in a multisite trial of a “housing first” intervention for homeless individuals with mental illness. A list of 79 housing unit, building, and neighborhood characteristics was generated from a review of the relevant literature and three focus groups with consumers and housing service providers. The characteristics were then ranked by 47 researchers, consumers, and service providers on perceived importance, generalizability, universality of value, and evidence base. Items were then drafted, scaled (five points, half values allowed), and pretested in seven housing units and with seven raters using cognitive interviewing techniques. The draft scale was piloted in 55 housing units in Toronto and Winnipeg, Canada. Items were rated independently in each unit by two trained research assistants and a housing expert. Data were analyzed using classical psychometric approaches and intraclass correlation coefficients (ICC) for inter-rater reliability. The draft scale consisted of 34 items assessing three domains: the unit, the building, and the neighborhood. Five of 18 unit items and 3 of 7 building items displayed ceiling or floor effects and were adjusted accordingly. Internal consistency was very good (Cronbach’s alpha = 0.90 for the unit items, 0.80 for the building items, and 0.92 total (unit and building)). Percent agreement ranged from 89 to 100 % within one response scale value and 67 to 91 % within one half scale value. Inter-rater reliability was also good (ICCs were 0.87 for the unit, 0.85 for the building, and 0.93 for the total scale). Three neighborhood items (e.g., distance to transit) were found to be most efficiently rated using publicly available information. The physical quality of housing can be reliably rated by trained but nonexpert raters using the OHQS. The tool has potential for improved measurement in housing-related health research, including addressing the limitations of self-report, and may also enable documenting the quality of housing that is provided by publicly funded housing programs.     

老年男性体检人群精神症状自评量表评定结果分析

目的探讨老年男性体检人群心理问题的患病水平及主要影响因素,为早期开展针对性防治措施提供数据支持。方法 2015年3月~7月在北京市某部队三甲医院常规体检的老年男性人群进行横断面调查,采用精神症状自评量表进行心理问题评估。结果本研究纳入1 132名老年男性体检对象,年龄60~99岁,平均(75.2±9.5)岁,其中80岁及以上共有405人,占35.8%;共有101名研究对象精神症状自评量表(SCL-90)阳性,阳性率为8.9%,其中,80岁及以上高龄老年人的阳性率为9.9%;SCL-90总分均值为24.5±23.2;影响老年男性体检人群心理健康的主要因子分别是强迫症状(9.9%)、躯体化(8.6%)和附加因子(8.6%),除了躯体化因子外,老年男性体检人群的SCL-90因子分显著低于军人与地方常模分数(P0.01);离异/丧偶、饮食偏好和睡眠障碍是影响老年男性人群心理健康问题的危险因素,其OR值分别为1.44(95%CI为1.29~1.76)、2.12(95%CI为1.38~3.24)和3.37(95%CI为2.31~4.93),而经常体育锻炼是老年男性人群心理健康的保护因素,其OR值为0.58(95%CI为0.31~0.86)。结论老年男性人群的精神心理问题患病率较低,婚姻状况、饮食偏好、体育锻炼和睡眠障碍是影响心理健康问题的重要因素。这提示需要重视老年人群尤其是离异/丧偶、存在睡眠障碍等的人群,并早期开展针对性的措施,以减少严重精神心理问题的发生。     

A qualitative exploration of facilitators and barriers to physical activity participation in people with severe mental illness in Taiwan

BackgroundIdentifying factors associated with physical activity participation is critical for developing effective programs for individuals with severe mental illness (SMI). Previous studies have focused on western, developed countries; the purpose of this study was to qualitatively identify physical activity facilitators and barriers in people with SMI in Taiwan.MethodThirty-nine community-dwelling participants participated in one of five focus groups. Semi-structured open-ended questions were asked to identify physical activity barriers and facilitators. Qualitative data was organized and analyzed with thematic analysis using ATLAS.ti. software.ResultsParticipants had a mean age of 42 (SD = 11), were primarily female (51.3%), and had a diagnosis of schizophrenia (84.6%). Five facilitators and five barriers related to physical activity participation in the SMI group were identified. Facilitators included motivation by the health benefits of physical activity, engagement in preferred types of activity, support from family and friends, encouragement from health professionals, and convenient access to exercise equipment and facilities. Barriers included poor health, low self-efficacy, low support from family and friends, fear of negative societal attitudes toward mental illness, and an unsupportive physical environment.ConclusionsFactors related to physical activity participation in Taiwanese with SMI are multidimensional and include personal, social and physical environment factors. Future physical activity promotion programs for similar Taiwanese populations with SMI may want to consider targeting multiple levels of influence to help increase physical activity.     

Caregiving in the shadows: National analysis of health outcomes and intensity and duration of care among those who care for people with mental illness and for people with developmental disabilities

BackgroundThe health impacts of caring for people with mental illness (MI) and developmental disabilities (DD) are not well understood.ObjectiveThe present study explored whether health outcomes differed between MI and DD caregivers, and if intensity and duration of care moderated health outcomes.MethodsNationally representative 2016 Behavioral Risk Factor Surveillance System survey data were used to explore how caring for people with MI (n = 1071) and DD (n = 888) impacted general health status and physical and mental health days, and whether intensity and duration of care moderated health outcomes. Logistic regression models and cumulative logistic regression models were used to model health outcomes.ResultsCaregivers had worse health (p = 0.0001) and more poor physical (p < 0.0001) and mental health days (p < 0.0001) than non-caregivers. Relative to DD caregivers, MI caregivers had worse health status (p = 0.02) and more poor physical (p = 0.02) and mental (p = 0.003) health days. As intensity of care increased, MI caregivers had more poor physical health days (p = 0.04) than DD caregivers and as duration of care increased, MI caregivers had worse health status (p = 0.03) than DD caregivers.ConclusionsAlthough the care provided to adults with DD was more intense and for a longer duration, MI caregivers had poorer health outcomes and were more impacted by intensity and duration of care. Implications for supporting MI and DD caregivers are discussed.     

Knowing is not doing: The relationship between health behaviour knowledge and actual health behaviours in people with serious mental illness

ObjectivesLow levels of physical activity and poor dietary habits are common in people with serious mental illness and contribute to the poorer overall health and early mortality observed in this population. This paper examines the relationships between health behaviour knowledge and self-reported health behaviours in people with serious mental illness.MethodsWe examined the health behaviour knowledge, level of physical activity, consumption of fruits and vegetables and attitudes towards saturated fat intake in 21 community-based mental health consumers in a regional city in Queensland, Australia. Relationships between dichotomous variables of health behaviour knowledge, physical activity levels, daily fruit and vegetable intake, and attitude towards saturated fat intake were examined using Phi coefficients and point biserial relationships respectively.ResultsThe mean score for health behaviour knowledge was 10.2 out of a possible maximum score of 14 points. No statistically significant relationships were observed between the dichotomous variables of health behaviour knowledge and level of physical activity, consumption of fruits and vegetables or attitudes towards saturated fat intake. A weak statistically significant relationship was observed between raw health knowledge score and the number of daily serves of vegetable.ConclusionsThe lack of significant relationships between health behaviour knowledge and self-reported health behaviours is supported by health behaviour theory which proposes that knowledge alone is insufficient to elicit behaviour. In this regard, people with serious mental illness may not be dissimilar to the general population.     

广州市护士心理健康水平及其相关因素分析

目的了解广州市护士的心理健康状况,分析其相关因素。方法对广州市4所医院的267名护士采用症状自评量表(SCL-90)及自行设计的个人一般情况调查表进行问卷调查。结果接受调查的护士心理健康状况不佳的检出率为22.85%,其人际关系、恐怖和精神病性3个因子分明显高于常模人群(P<0.01),不同婚姻状况、在编情况、工龄间的躯体化因子分存在显著性差异(P<0.05),不同从业目的间敌对、偏执因子分存在显著性差异(P<0.01)。结论护士心理健康状况欠佳,与社会因素有较为密切的关系,社会、政府、医院应采取适当的综合干预措施改善护士的心理健康水平。     

Outcome assessments used in studies examining the effect of prescribed exercise interventions for people living with severe mental illness,a scoping review

BackgroundExercise interventions are increasingly incorporated in the management of severe mental illness; however, best practice screening and outcome monitoring for this unique population are yet to be established. This review aims to explore assessment measures reported in publications of exercise interventions in severe mental illness.MethodsA scoping review was implemented with a structured search of Embase, PubMed, Medline, PsychINFO, Scopus, and SportDiscus using terms related to severe mental illness, exercise, and health. Studies were included if they incorporated an exercise intervention for people with severe mental illness and measured physical and/or mental health outcomes. Studies were analysed for population, assessment measures, and methodological quality.Results1832 studies were identified and following screening and full text review 38 studies involving 2854 participants were included for analysis, primarily psychotic (n = 13), depressive disorder (n = 9) and mixed severe mental illness populations (n = 13). The most frequently reported health domains and assessment measures used included body composition (weight and body mass index), symptom severity, cardiorespiratory fitness (volume of oxygen consumption), cardiometabolic health (blood pressure and metabolic blood sampling), and quality of life. Methodological quality varied with 13 determined as good, 12 fair, and 13 poor.ConclusionThe review identified domains and assessment tools frequently reported in the exercise and severe mental illness literature. However, given the heterogeneity and scarcity of the research, along with lack of reporting of sufficient detail, best-practice clinical recommendations are still limited. There remains a need to establish best practice assessment and monitoring procedures within exercise interventions in severe mental illness.     

The association between physical exercises and health-related quality of life in subjects with mental disorders: results from a cross-sectional survey

OBJECTIVES: The present study examines the relationship between health-related quality of life and physical activity among adults with affective, anxiety, and substance dependence disorders. METHODS: Analyses were conducted among participants in the German National Health Interview and Examination Survey (GHS), a nationally representative multistage probability survey, conducted from 1997 to 1999. Multiple linear regression analyses were used to determine the relationship between health-related quality of life and physical activity among subjects with mental disorders. RESULTS: Affective, anxiety, and substance dependence disorders were associated with substantial impairment in health-related quality of life. Higher levels of physical activity were associated with higher health-related quality of life among persons with mental disorders. Even after controlling for sociodemographic characteristics, physically inactive subjects reported poorer quality of life. CONCLUSIONS: Physical activity can be considered as beneficial for people suffering from mental disorders. The promotion of a physically active lifestyle is an important public health objective.     

不同危险因素人群的社区脑卒中干预效果评估

目的评价社区脑卒中干预在不同危险因素人群中的效果。方法1987年在北京和长沙两城市各选择2个不相邻、框架人口约为1万的自然人群,分别作为干预和对照社区,从2个社区35岁以上人群中分别选取2700名既往无脑卒中病史的居民作为队列人群,进行脑卒中危险因素基线调查,两城市共入选干预队列5319人,对照队列5506人。在干预队列,对筛查出的高危对象进行社区干预,对照队列的人群则顺其原有医疗不予干预。干预时间为12年。结果干预队列脑卒中发病的危险比对照队列低22%(HR=0.78,95%CI:0.66～0.92)。无论居民是否有脑卒中的危险因素,干预队列脑卒中发病率都低于对照队列,无论教育水平如何、是否肥胖或超重,脑卒中发病率均有明显降低,但是在男性、吸烟和饮酒者中脑卒中发病率在干预组和对照组比较其差异无统计学意义。干预队列脑卒中死亡率明显低于对照队列(HR=0.27,95%CI:0.17～0.42)。脑卒中死亡率在不同危险因素水平均有明显的降低(P<0.05)。结论经过长期的社区干预,不仅可以降低高危人群脑卒中的发病和死亡危险,无危险因素的社区居民也受益。但是男性、吸烟和饮酒者的干预还亟待加强。     

多元社会参与及家庭支持对中国老年人心理健康的影响研究

目的：了解不同社会参与类型和家庭支持对老年人心理健康的影响及交互作用,为促进老年人心理健康提供决策依据。方法：基于2018年中国老年健康影响因素跟踪调查（CLHLS）数据筛选获得12 686名老年人,使用描述性分析、Pearson相关性检验、二元logistic回归模型研究不同社会参与、家庭支持特征的老年人心理健康现状及相关性,分析其对老年人积极、消极情绪的影响,探讨多元社会参与类型间的交互作用。结果：有社会参与和家庭支持的老年人心理健康较好的发生比高达5.72%~17.50%;休闲娱乐型、社会交往型社会参与及与家人同住对老年人心理健康有显著促进效应,且该两类社会参与间存在显著交互作用,家务型社会参与则对心理健康有负向影响。结论：不同类型社会参与对老年人心理健康的影响存在差异和部分互替性,与家人同住为代表的家庭支持能显著改善老年人的心理健康水平,应鼓励老年人更多地参与社会活动、与家人共同居住,以提高老年人的积极情绪,降低消极情绪的发生风险。     

农民工、城市居民、农村居民心理韧性及对心理健康的影响

目的 了解农民工、城市居民、农村居民的心理韧性与心理健康现状及差异,分析心理韧性对心理健康的影响。方法 采用心理韧性量表和简要症状量表,通过多水平分层空间随机抽样方法抽取武汉市18～45岁1 135名农民工、1 145名农村居民和1 249名城市居民,使用电脑语音辅助问自答卷技术进行问卷调查。结果 农民工、农村居民、城市居民心理韧性总得分分别为（3.48±0.65）、（3.43±0.65）、（3.39±0.63）分,农民工心理韧性水平高于城市居民,差异有统计学意义（F = 5.655,P = 0.004）。农民工、农村居民、城市居民简要症状量表得分分别为（1.96±0.61）、（1.99±0.57）、（2.05±0.58）分,城市居民心理健康水平低于农民工和农村居民,差异有统计学意义（F = 8.036,P＜0.001）。心理韧性各维度和心理健康状况各维度之间均具有相关性(r为-0.132～-0.062,P值均小于0.001)。广义线性模型分析结果显示,控制其他因素后,心理韧性中的情感韧性对心理健康各维度均有正向预测作用（P＜0.001）。结论 心理韧性可以预测心理健康状况,农民工的心理韧性和心理健康水平都相对较高。