Determinants of Physical Health Self-Management Behaviours in Adults With Serious Mental Illness: A Systematic Review

The Mediating Role of General Self-Efficacy in Health Self-Management and Psychological Stress Among Older Adults in Shanghai: A Structural Equation Modeling Analysis

BACKGROUND

Given the demographic shift towards an older population, it is crucial to understand the determinants and implications of psychological distress among this demographic group. This study explores the relationship between health self-management and psychological distress in older Chinese adults, focusing on the mediating role of general self-efficacy (GSE).

METHODS

We conducted a cross-sectional study in five districts of Shanghai from 1 November to 31 December 2021, employing a random cluster sampling method. Data were collected using the Health Self-Management Scale, the General Self-Efficacy Scale (GSES), and the Kessler-10 Scale. Out of 2050 participants approached, 1905 completed the survey, resulting in a response rate of 91.76%. Data analysis included correlation studies, hierarchical linear regression, and structural equation modeling.

RESULTS

The average Kessler-10 score among elderly individuals in Shanghai was 15.59 ± 6.35. Of these, 22.10% had mild psychological distress, 11.92% had moderate stress, and 5.30% had severe stress. We found significant negative correlations between psychological distress and health self-management (r = -0.34, p < 0.05) and GSE (r = -0.26, p < 0.05). Health self-management had a total effect of -0.284 (95%CI: -0.330 to -0.234) on psychological distress, with GSE mediating approximately 20.42% of this effect.

CONCLUSIONS

GSE plays a significant mediating role between health self-management and psychological distress. These findings highlight the importance of promoting health self-management and GSE to alleviate psychological distress among older adults in Shanghai. This approach could enhance holistic health outcomes and improve the quality of life within this growing population segment.

Relationships Among Demographic Factors, Stigma, Social Support, and Self-Management in Individuals With Bipolar Disorder in Remission

The current cross-sectional study aimed to investigate the extent to which demographic characteristics, stigma, and social support impact the self-management abilities of individuals with bipolar disorder in remission. Participants (N = 114) completed a demographic questionnaire, Self-Stigma Scale-Short Form, Social Support Rating Scale, and Self-Management Scale for Patients With Bipolar Disorder. Mean scores were 60.65 (SD = 10.42) for self-management, 35.76 (SD = 7.14) for social support, and 21.38 (SD = 5.06) for stigma. In the univariate analysis, age, educational level, method of payment for care, illness duration, and number of hospitalizations demonstrated significant associations with self-management (p < 0.05). Correlation analysis revealed a positive correlation between self-management and social support (r = 0.574, p < 0.01) and negative correlations between self-management and stigma (r = -0.489, p < 0.01) and stigma and social support (r = -0.476, p < 0.01). Multiple linear regression analysis included number of hospitalizations (β = -3.818), social support (β = 0.436), literacy (β = 2.132), and stigma (β = -0.397). Individuals in remission from bipolar disorder exhibit moderate levels of self-management. Follow-up interventions should prioritize enhancing social support and addressing stigma to promote improved self-management and overall well-being. [Journal of Psychosocial Nursing and Mental Health Services, 62(7), 26-35.].

Living with schizophrenia and type 2 diabetes and the implication for diabetes self-care: A qualitative study

AIM

To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care.

DESIGN

The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews.

METHODS

Data were collected during 2020-2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research.

RESULTS

Three key themes emerged: 'Diabetes when life is noisy', 'Sacrifices and compromises in life' and 'The double silence'. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment.

CONCLUSION

Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways.

IMPLICATIONS FOR PATIENT CARE

The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.

Somatic health according to people with severe mental disease

OBJECTIVES

Patients with schizophrenia have a 15- to 20-year shorter life expectancy compared with the general population. The aim of this study was to explore these patients' perception of their physical health.

METHODS

A patient reported outcomes measure (PROM) has been developed by patients with severe mental disease. This survey had to better capture undetected, under-rated and non-prioritized physical domains by traditional routine clinical scales that are important for people who live with mental health disease. These patients have tested the applicability of this PROM with peers with severe mental disease in medical, social and community-based centers from Hauts-de-France.

RESULTS

Two and a half years have been required to develop this PROM, to test its applicability to patients with severe mental disease and to analyze the results. The study process has been slowed by the sanitary context induced by the COVID-19 pandemic. Thirty-two questionnaires have been collected by the participants. Despite this low number of data, participants have been satisfied by the results and their experience. The results show that people with severe mental disease consider physical health as a major concern, notably pain and somatic diseases. External factors (such as accessibility to health care and medication) and internal factors (such as self-esteem, cognitive and negative symptoms, sleep, alimentation, and substance use) have been identified as barriers for physical health.

CONCLUSIONS

These results support the development of PROMs highlighting personal experience of people with severe mental disease. The data obtained thanks to these measures will allow to build programs to help them to cope with barriers for physical health.

Exploring the Use of Digital Interventions by People with Severe Mental Illness to Support Their Physical Health: A Mixed Methods Study

People with severe mental illness (SMI) are more likely to experience physical health conditions than the general population. Little is known about the experience of people with SMI using digital health interventions (DHIs) to support their physical health. We explored how people with SMI use DHIs to support their physical health, the acceptability, factors affecting use, and impact on physical health. This was a three-stage mixed methods study (1) online survey of people with SMI; (2) interviews with a subsample of participants from Stage 1; (3) stakeholder workshops. Participants were generally satisfied with the DHIs they used. The most popular DHIs were targeted at diet, exercise, and weight management. Factors that encouraged use included simplicity and data-linkage. Concerns included costs, data security, and reliability of information. Positive impacts included accountability and tangible physical health benefits. Mental health impacted engagement with DHIs. DHIs were seen as a useful tool to monitor physical health but could not replace contact with clinical services. DHIs were considered useful and acceptable by people with SMI and may be used as an extension of clinical care. The specific needs and priorities of people with SMI should be considered both in developing and recommending interventions.

Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review

BACKGROUND

The main contributor to excess mortality in severe mental illness (SMI) is poor physical health. Causes include unfavorable health behaviors among people with SMI, stigmatization phenomena, as well as limited access to and utilization of physical health care. Patient centered interventions to promote the utilization of and access to existing physical health care facilities may be a pragmatic and cost-effective approach to improve health equity in this vulnerable and often neglected patient population.

OBJECTIVE/METHODS

In this study, we systematically reviewed the international literature on such studies (sources: literature databases, trial-registries, grey literature). Empirical studies (quantitative, qualitative, and mixed methods) of interventions to improve the utilization of and access to medical health care for people with a SMI, were included.

RESULTS

We identified 38 studies, described in 51 study publications, and summarized them in terms of type, theoretical rationale, outcome measures, and study author's interpretation of the intervention success.

CONCLUSIONS

Useful interventions to promote the utilization of physical health care for people with a SMI exist, but still appear to be rare, or at least not supplemented by evaluation studies. The present review provides a map of the evidence and may serve as a starting point for further quantitative effectiveness evaluations of this promising type of behavioral intervention.

A theory and evidence-based co-design approach to develop a supported self-management intervention for people with severe mental illness and type 2 diabetes (Preprint)

BACKGROUND

Type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the inequalities they experience within health care services.

OBJECTIVE

We combined theory, empirical evidence, and co-design approaches to develop a type 2 diabetes self-management intervention for people with SMI.

METHODS

The development process encompassed 4 steps: step 1 involved prioritizing the mechanisms of action (MoAs) and behavior change techniques (BCTs) for the intervention. Using findings from primary qualitative research and systematic reviews, we selected candidate MoAs to target in the intervention and candidate BCTs to use. Expert stakeholders then ranked these MoAs and BCTs using a 2-phase survey. The average scores were used to generate a prioritized list of MoAs and BCTs. During step 2, we presented the survey results to an expert consensus workshop to seek expert agreement with the definitive list of MoAs and BCTs for the intervention and identify potential modes of delivery. Step 3 involved the development of trigger films using the evidence from steps 1 and 2. We used animations to present the experiences of people with SMI managing diabetes. These films were used in step 4, where we used a stakeholder co-design approach. This involved a series of structured workshops, where the co-design activities were informed by theory and evidence.

RESULTS

Upon the completion of the 4-step process, we developed the DIAMONDS (diabetes and mental illness, improving outcomes and self-management) intervention. It is a tailored self-management intervention based on the synthesis of the outputs from the co-design process. The intervention incorporates a digital app, a paper-based workbook, and one-to-one coaching designed to meet the needs of people with SMI and coexisting type 2 diabetes.

CONCLUSIONS

The intervention development work was underpinned by the MoA theoretical framework and incorporated systematic reviews, primary qualitative research, expert stakeholder surveys, and evidence generated during co-design workshops. The intervention will now be tested for feasibility before undergoing a definitive evaluation in a pragmatic randomized controlled trial.

The lived experience of severe mental illness and long-term conditions: a qualitative exploration of service user, carer, and healthcare professional perspectives on self-managing co-existing mental and physical conditions

BACKGROUND

People with severe mental illness (SMI), such as schizophrenia, have higher rates of physical long-term conditions (LTCs), poorer health outcomes, and shorter life expectancy compared with the general population. Previous research exploring SMI and diabetes highlights that people with SMI experience barriers to self-management, a key component of care in long-term conditions; however, this has not been investigated in the context of other LTCs. The aim of this study was to explore the lived experience of co-existing SMI and LTCs for service users, carers, and healthcare professionals.

METHODS

A qualitative study with people with SMI and LTCs, their carers, and healthcare professionals, using semi-structured interviews, focused observations, and focus groups across the UK. Forty-one interviews and five focus groups were conducted between December 2018 and April 2019. Transcripts were coded by two authors and analysed thematically.

RESULTS

Three themes were identified, 1) the precarious nature of living with SMI, 2) the circularity of life with SMI and LTCs, and 3) the constellation of support for self-management. People with co-existing SMI and LTCs often experience substantial difficulties with self-management of their health due to the competing demands of their psychiatric symptoms and treatment, social circumstances, and access to support. Multiple long-term conditions add to the burden of self-management. Social support, alongside person-centred professional care, is a key facilitator for managing health. An integrated approach to both mental and physical healthcare was suggested to meet service user and carer needs.

CONCLUSION

The demands of living with SMI present a substantial barrier to self-management for multiple co-existing LTCs. It is important that people with SMI can access person-centred, tailored support for their LTCs that takes into consideration individual circumstances and priorities.

Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis

BACKGROUND

People living with severe mental illness (SMI) have a reduced life expectancy by around 15-20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, facilitators and strategies for self-management of LTCs for people with SMI.

AIM

To systematically review and synthesise the qualitative evidence exploring facilitators, barriers and strategies for self-management of physical health in adults with SMI, both with and without long-term conditions.

METHODS

CINAHL, Conference Proceedings Citation Index- Science, HMIC, Medline, NICE Evidence and PsycInfo were searched to identify qualitative studies that explored barriers, facilitators and strategies for self-management in adults with SMI (with or without co-morbid LTCs). Articles were screened independently by two independent reviewers. Eligible studies were purposively sampled for synthesis according to the richness and relevance of data, and thematically synthesised.

RESULTS

Seventy-four articles met the inclusion criteria for the review; 25 articles, reporting findings from 21 studies, were included in the synthesis. Seven studies focused on co-morbid LTC self-management for people with SMI, with the remaining articles exploring self-management in general. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the burden of SMI; living with co-morbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; and routine, structure and planning.

CONCLUSIONS

The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources. To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population.