Physical Activity Patterns Among U.S. Adults with and without Serious Psychological Distress

Objective

A physically active lifestyle is recommended for overall health—both physical and mental. Serious psychological distress (SPD) is associated with adverse health behaviors. We compared patterns of physical activity (PA) among adults with and without SPD using current public health guidelines for PA and examined whether adults with SPD were physically active at recommended levels.

Methods

We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to assess SPD using the Kessler 6 (K6) scale of nonspecific psychological distress and PA categories based on the 2008 U.S. Department of Health and Human Services guidelines. Complete data were available for 78,886 adults in 16 states that used an optional BRFSS mental illness and stigma module containing the K6 scale. We performed multiple logistic regression analyses to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).

Results

The unadjusted prevalence of SPD was 3.9% (95% CI 3.6, 4.2), and the age-adjusted prevalence of SPD was 3.8% (95% CI 3.5, 4.1). After adjusting for age, sex, race/ethnicity, education, employment, body mass index, smoking status, and heavy drinking, adults with SPD were significantly less likely to be physically active at recommended levels than adults without SPD. PRs were attenuated but remained significant after further adjustment for limitations to PA.

Conclusion

Adults with SPD are less likely to meet current PA recommendations than adults without SPD, highlighting the need for targeted interventions.Serious psychological distress (SPD), while not indicative of a specific mental illness, is associated with anxiety and mood disorders.^1,2 In 2012, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) compared National Survey on Drug Use and Health (NSDUH) mental health data with other data sources.³ SAMHSA reported that the estimated prevalence of past-year SPD was 10.2% using the 2009 NSDUH. The estimated prevalences of past-year serious mental illness and any mental illness (i.e., ≥1 mental disorder excluding substance abuse) were 4.8% and 19.9%, respectively, using NSDUH data, and 5.8% and 24.8%, respectively, using National Comorbidity Survey Replication data.^3,4 Past 30-day estimates of SPD were 3.1% using National Health Interview Survey (NHIS) data, 4.6% using NSDUH data, and 4.8% using Medical Expenditure Panel Survey (MEPS) data.³SPD is frequently comorbid with chronic physical conditions and disabilities, resulting in an increased risk for adverse health outcomes and premature death.^5–7 In addition, SPD is highly associated with adverse health behaviors, such as smoking, physical inactivity, and substance abuse.^8–11 The economic costs of mental disorders are substantial. While an estimated 6.2% of U.S. health-care spending is attributed to mental disorders,¹² the true cost of these disorders is elusive, as they are mainly indirect, such as increased work absenteeism and decreased productivity, increased risk of unemployment and subsequent reliance on social services disability income, and other adverse consequences (e.g., reduced educational attainment, homelessness, and incarceration).^13,14The overall health benefits of physical activity (PA) are well known.^11,15–23 In 2008, the U.S. Department of Health and Human Services (HHS) published revised PA recommendations informed by the most recent scientific evidence available. These new public health guidelines recommend a physically active lifestyle not only for physical health but also for mental health.²³ Similarly, many organizations have recognized the intertwined relationship between mental and physical health, especially the role PA has in improving and maintaining mental health.^{11,15,17–22,24–26} For example, the American Psychiatric Association''s (APA''s) clinical practice guidelines include PA as an initial treatment modality in patients with mild depressive disorder, and as an adjunct therapy for patients no matter the severity of depression.^17,22 Given the comprehensive health benefits of PA, further elucidation of the PA patterns among adults with SPD is needed to establish a baseline and to inform public health strategies; primary care collaborative care models; and clinical protocols designed to prevent adverse health outcomes, treat mental disorders, and improve the quality of life among this population.Thus, this study had two goals: (1) to compare the PA patterns of adults with and without SPD and (2) to examine whether adults with SPD are physically active in accordance with the 2008 HHS PA guidelines.