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Milos Nymberg V, Nymberg P, Pikkemaat M, Calling S, Stenman E, Grundberg A, Smith JG, Sundquist K. Lifestyle and cardiovascular risk factors in a Swedish primary care population with self-reported psychiatric symptoms. Prev Med Rep 2024; 37:102547. [PMID: 38174323 PMCID: PMC10761795 DOI: 10.1016/j.pmedr.2023.102547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Objective Individuals with psychiatric illness suffer from poorer physical health compared with the general population and have a higher risk of developing cardiovascular and metabolic diseases. This cross-sectional study aims to describe the prevalence of lifestyle and cardiovascular risk factors and the association with self-reported psychiatric symptoms in a population of 40-year-old individuals screened with targeted Health Dialogues in southern Sweden. Methods All 40-year-old individuals registered at 99 primary healthcare centers in southern Sweden were invited to participate. Self-reported lifestyle habits on a web questionnaire, anthropometric measurements, blood pressure, and blood tests were collected. The Health Dialogue resulted in a risk level assessment for different lifestyle habits and a meeting with a trained coach. Results A total of 1831 individuals completed a Health Dialogue between 1st January 2021 and 30th June 2022. There were more individuals with high-risk levels for several lifestyle habits in the group with self-reported psychiatric illness compared with the rest of the study population. The analysis showed that physical inactivity, unhealthy diet, high-risk alcohol intake, tobacco use, psychosocial strain, higher BMI, and waist-hip ratio were associated with increased levels of psychiatric symptoms after adjustment for sex and socioeconomic factors. Conclusion Unhealthy lifestyle habits were associated with self-reported psychiatric symptoms in 40-year-old individuals assessed with targeted Health Dialogues in a primary care context. Organized screening might contribute to early detection of modifiable risk factors for cardiovascular disease. Individuals with psychiatric symptoms should be prioritized for screening of unhealthy lifestyle behaviors.
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Affiliation(s)
- Veronica Milos Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Primary Care Skåne, Region Skåne, Sweden
| | - Peter Nymberg
- School of Health and Welfare, Halmstad University, Sweden
| | - Miriam Pikkemaat
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Primary Care Skåne, Region Skåne, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Primary Care Skåne, Region Skåne, Sweden
| | - Emelie Stenman
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Anton Grundberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - J. Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Primary Care Skåne, Region Skåne, Sweden
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Milos Nymberg V, Pikkemaat M, Calling S, Nymberg P. HEAD-MIP-(HEAlth Dialogues for patients with Mental Illness in Primary care)-a feasibility study. Pilot Feasibility Stud 2023; 9:167. [PMID: 37770967 PMCID: PMC10538239 DOI: 10.1186/s40814-023-01391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Patients with mental illness have an increased risk of cardiovascular morbidity and mortality compared to the rest of the population, which is partly related to unhealthy lifestyle habits. To individualise lifestyle counselling in primary care, the Swedish-developed Health Dialogue (HD) can be used as an educative tool at recurrent measurement points with the goal to improve non-healthy lifestyle habits. HD has not been aimed specifically at patients with mental illness, and the effect of a systematic approach with repeated HDs in patients with mental illness in primary care has not been previously studied. The aim of this pilot study was to assess the feasibility of the study design for a larger-scale cohort study using repeated HDs focused on the improvement of lifestyle habits in patients seeking primary care due to anxiety, depression, sleeping problems or stress-related symptoms. METHODS Patients were recruited after a visit to a Primary Health Care Center due to mental illness between October 2019 until November 2021 and received a Health Dialogue, including an assessment of cardiovascular risk factors through a Health Curve. Specific feasibility objectives measured were dropout rate, time to follow-up, and risk improvement rate for different lifestyle changes. RESULTS A total of 64 patients were recruited and 29 (45%) attended a second HD, with a mean follow-up time of 15 months. All participants had at least one elevated cardiovascular risk level on the Health Curve for the assessed lifestyles. Risk level improvement rate was good except for tobacco use. CONCLUSION Despite a higher dropout rate than expected, we suggest that the proposed methodology for a full cohort study within general practice of patients with mental illness in primary care is both acceptable to practice and feasible. TRIAL REGISTRATION NCT05181254 . Registered January 6th, 2022. Retrospectively registered.
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Affiliation(s)
- Veronica Milos Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - Miriam Pikkemaat
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Peter Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Lovén Wickman U, Schmidt M. Experiences of primary care among young adults with mental illness - A systematic literature review. Scand J Caring Sci 2023; 37:628-641. [PMID: 36971467 DOI: 10.1111/scs.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Mental illness, such as depression, anxiety disorders, attention deficit hyperactivity disorder and different addictive diseases, has increased among young adults over the last decade. Mental illness is associated with distress and problems functioning in social activities. Healthcare centres, that is, primary care, serve as the first point of contact with healthcare professionals for those young adults and provide outpatient medical and nursing care covering both physical and mental illness. OBJECTIVE To explore experiences of primary care among young adults with mental illness. METHODS A systematic literature review was conducted that followed the method of Bettany-Saltikov and McSherry. A keyword search was performed in various databases, and after a quality assessment 23 articles were included in the review. RESULTS Young adults' experiences from primary care are described in four categories - Facing difficulties to accept help, relational preconditions, structural and organisational hindrances and satisfaction with youth-focused mental health interventions. Young adults with mental illness experience many difficulties in accessing and receiving proper help from primary care. Further, they did not believe in recovery from mental illness, and they also expressed a lack of mental health literacy. CONCLUSION While being the first contact with healthcare professionals, primary care needs to adjust its services to address the growing group of young adults suffering from mental illness. It is necessary to provide tailored guidelines and interventions in primary care for young adults with mental illness, and the Tidal Model may improve the contacts with young adults in primary care.
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Affiliation(s)
- Ulrica Lovén Wickman
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Manuela Schmidt
- Department of Quality Improvement and Leadership, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Happell B, Furness T, Jacob A, Stimson A, Curtis J, Watkins A, Platania-Phung C, Scholz B, Stanton R. Nurse-Led Physical Health Interventions for People with Mental Illness: A Scoping Review of International Literature. Issues Ment Health Nurs 2023:1-16. [PMID: 37294933 DOI: 10.1080/01612840.2023.2212772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
People with mental illness have a higher prevalence of co-occurring physical health conditions and poor health behaviors, leading a mortality gap of up to 16 years, compared with the general population. Nurses working in mental health settings play an important role in addressing factors influencing sub-optimal physical health. Therefore, this scoping review aimed to identify nurse-led physical health interventions and align interventions to eight recognized physical healthcare priority areas (i.e. Equally Well in Victoria Framework). A systematic search strategy was used to identify relevant literature. Data extraction included alignment to the Equally Well priority areas, research design, and indication of co-design (meaningful and collaborative involvement of consumers and significant others) and recovery-oriented practice (focusing on needs and goals of a consumer's recovery journey). All included papers (n = 74) were aligned to at least one of eight Equally Well priority areas. Papers were predominately quantitative (n = 64, 86%), with the remainder mixed methods (n = 9, 9%) or qualitative (n = 4, 5%). Most papers were aligned to improving metabolic health and support to quit smoking. One study focused on nurse-led intervention designed to reduce falls. Recovery-oriented practice was evident in six papers. No paper described evidence of co-design. A research gap was identified for nurse-led intervention to reduce falls and improve dental/oral care. Relative to mental healthcare policy, there is a need for future nurse-led physical health research to be co-designed and include recovery-oriented practice. Evaluation and description of future nurse-led physical interventions should seek to report perspectives of key stakeholders as these remain relatively unknown.
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Affiliation(s)
- Brenda Happell
- Mental Health and Psychosocial Well-being Theme, Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Alycia Jacob
- School of Nursing and Midwifery, Australian Catholic University, Fitzroy, Australia
| | - Alisa Stimson
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Rockhampton, Queensland, Australia
| | - Jackie Curtis
- Mindgardens Neuroscience Network, South East Sydney Local Health District, University of New South Wales - Cliffbrook Campus, Coogee, Australia
| | - Andrew Watkins
- Mindgardens Neuroscience Network, South East Sydney Local Health District, University of New South Wales - Cliffbrook Campus, Coogee, Australia
| | | | - Brett Scholz
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Robert Stanton
- Cluster for Resilience and Wellbeing, Appleton Institute, Rockhampton, South Australia, Australia
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Queensland, Australia
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Punzo K, Skoglund M, Carlsson IM, Jormfeldt H. Experiences of an Equine-Assisted Therapy Intervention among Children and Adolescents with Mental Illness in Sweden - A Nursing Perspective. Issues Ment Health Nurs 2022; 43:1080-1092. [PMID: 36178465 DOI: 10.1080/01612840.2022.2126571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Mental illness among children and adolescents is increasing globally, and prescription of psychiatric drugs for children and adolescents with mental illness is increasing worldwide, including Sweden. Holistic health-promoting interventions have shown promising long-lasting significant health benefits in young individuals with mental illness, but holistic health-promoting mental health interventions are often disregarded due to a lack of systematic theory-based knowledge. Consequently, the lack of scientific knowledge thwarts implementation of equine-assisted therapy as an established intervention in mental health nursing for children and adolescents with mental illness. The purpose of the study was to better understand experiences of equine-assisted therapy among children and adolescents with mental illness. The study adopted an inductive approach and data was collected using photovoice methodology. Six young persons, 7-18 years of age, referred by a psychologist to the equine-assisted intervention due to mental health issues, were included in the study. Data was analyzed using qualitative content analysis. The results could be summarized by an overarching theme, a physical, emotional, and social milieu for growth, consisting of three subcategories: feeling relief from everyday stress and anxiety; nurturing self-esteem in a mutual friendship; and strengthening self-reliance through synchronized interplay. The results indicate that equine-assisted therapy has essential values closely related to the goals of mental health nursing. Further research should strive to attain even gender distribution in study samples and focus on how equine-assisted therapy could be thoroughly integrated into established nursing intervention for children and adolescents with mental illness.
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Affiliation(s)
- Kim Punzo
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Matilda Skoglund
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Tabvuma TS, Stanton R, Browne G, Happell B. Mental health consumers' perspectives of physical health interventions: An integrative review. Int J Ment Health Nurs 2022; 31:1046-1089. [PMID: 35388954 PMCID: PMC9542531 DOI: 10.1111/inm.13000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 12/12/2022]
Abstract
Consumers of mental health services experience poor physical health compared to the general population, leading to long-term physical illness and premature death. Current research and policy activity prioritizes the physical health of consumers yet few of these recommendations have translated to practice. This implementation gap may be influenced by the paucity of literature exploring consumer perceptions and experiences with physical healthcare and treatment. As a result, little is understood about the views and attitudes of consumers towards interventions designed to improve their physical health. This integrative review aims to explore the literature regarding consumer perspectives of physical healthcare and, interventions to improve their physical health. A systematic search was undertaken using (i) CINAHL, (ii) MEDLINE, (iii) PsycINFO, (iv) Scopus, and (v) Google Scholar between September and December 2021. Sixty-one papers comprising 3828 consumer participants met the inclusion criteria. This review found that consumers provide invaluable insights into the barriers and enablers of physical healthcare and interventions. When consumers are authentically involved in physical healthcare evaluation, constructive and relevant recommendations to improve physical healthcare services, policy, and future research directions are produced. Consumer evaluation is the cornerstone required to successfully implement tailored physical health services.
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Affiliation(s)
- Tracy Samkele Tabvuma
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Graeme Browne
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Structured assessment of modifiable lifestyle habits among patients with mental illnesses in primary care. Sci Rep 2022; 12:12292. [PMID: 35853972 PMCID: PMC9296453 DOI: 10.1038/s41598-022-16439-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
Patients with mental illness have an increased risk of cardiovascular morbidity. The Swedish-developed Health Dialogue is a pedagogical tool to individualize lifestyle counselling, used in specific age-groups to improve lifestyle habits and decrease mortality, but not tested specifically for patients with mental illness. Patients > 18 years old seeking primary care due to symptoms related to mental illness and diagnosed with depression, sleeping disorders, stress and anxiety, were included. A nurse-led health dialogue was conducted, focusing on lifestyle habits, anthropometric measurements, and blood samples, resulting in tailored advice regarding the individual's risk profile. All 64 participants had lifestyle areas with increased risk level. Approximately 20% had elevated fasting glucose, blood pressure or cholesterol levels, and over 40% had highest risk level in Waist-Hip-Ratio. 30% were overweight, or physical inactive. The results suggest the need of a larger cohort study with long-term follow up, to establish potentially positive effects on wellbeing, and decreased cardiovascular risk in patients with mental illness.Clinical trial registration: The study was registered at ClinicalTrials.gov January 6th, 2022, registration number NCT05181254.
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Watkins A, Denney-Wilson E, Curtis J, Teasdale S, Rosenbaum S, Ward PB, Stein-Parbury J. Keeping the body in mind: A qualitative analysis of the experiences of people experiencing first-episode psychosis participating in a lifestyle intervention programme. Int J Ment Health Nurs 2020; 29:278-289. [PMID: 31840386 DOI: 10.1111/inm.12683] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Andrew Watkins
- Keeping the Body in Mind Program, The Bondi Centre, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia.,Faculty of Health, University of Technology, Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Denney-Wilson
- Faculty of Medicine and Health, University of Sydney, Sydney, Sydney, New South Wales, Australia
| | - Jackie Curtis
- Keeping the Body in Mind Program, The Bondi Centre, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, Sydney, New South Wales, Australia
| | - Scott Teasdale
- Keeping the Body in Mind Program, The Bondi Centre, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, Sydney, New South Wales, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Sydney, New South Wales, Australia
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, Sydney, New South Wales, Australia.,Schizophrenia Research Unit, Ingham Institute for Applied Medical Research, Liverpool Hospital, South Western Sydney Local Health District, Bondi Junction, New South Wales, Australia
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology, Sydney, Sydney, New South Wales, Australia
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Bessaha ML, Sabbath EL, Morris Z, Malik S, Scheinfeld L, Saragossi J. A Systematic Review of Loneliness Interventions Among Non-elderly Adults. CLINICAL SOCIAL WORK JOURNAL 2020; 48:110-125. [PMID: 0 DOI: 10.1007/s10615-019-00724-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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