Physical Health Parameters: Comparison of People with Severe Mental Illness with the General Population
Northey, Alyce, Barnett, Fiona, British Journal of Occupational Therapy
According to the World Health Organization (WHO), in 2003 there were 450 million people with mental illness, over 150 million people with depression, nearly 1 million people committing suicide each year, 25 million people with schizophrenia, and more than 90 million with alcohol or drug use disorders (WHO 2003). The literature defines severe mental illness (SMI) as '... severe in degree and persistent in duration, which causes a substantially diminished level of functioning in the primary aspects of daily living ...' (Council of Australian Governments Mental Health Group--Queensland 2006, pi) and includes schizophrenia, bipolar disorder, affective, anxiety and substance dependence disorders, personality disorders and depression.
Weight gain and obesity are commonly associated with SMI and can lead to chronic physical conditions, including diabetes, stroke, heart disease, some cancers and osteoarthritis (Brown et al 2006). Physical exercise can help to reduce morbidity and mortality from these chronic conditions (Schmitz et al 2004); it can also improve physical health measures, such as weight, endurance, cardiovascular fitness and body fat percentage (Skrinar et al 2005). Regular exercise in a supportive environment is believed to improve general wellbeing and mental health in people with SMI (Schmitz et al 2004, Skrinar et al 2005). Participation in regular physical exercise is seen as the best single predictor of long-term weight loss (Blair et al 1996), encouraging researchers and health professionals to develop appropriate physical activity programmes for people with SMI.
The International Classification of Functioning, Disability and Health (ICF) (WHO 2009) determines health and wellbeing as a balance of individual, body, societal and environmental factors. The ICF defines impairments as problems in body functions and structure, leading to activity limitations that contribute to participation restrictions in life. This holistic approach is aligned with occupational therapy philosophy, providing guidelines by which to explore the impact that illness and disability have on an individual. Physiological limitations, such as chronic conditions, can have an impact on functional capacity and limit an individual's ability to complete activities of daily living (ADL) (WHO 2009).
Poor physical health among people with SMI has been identified in national and international literature (Brown et al 2006, Roick et al 2007, Smith et al 2007). Compared with the general population, people with SMI have a greater incidence of physical illnesses. However, it is unclear whether this disparity exists in North Queensland, Australia. This study hypothesised that the physical health parameters and physical activity levels of people with SMI in North Queensland would be different to people from the general population.
The specific objectives of the study were:
1. To determine the physical health parameters and physical activity levels of people with SMI
2. To determine the physical health parameters and physical activity levels of the general population.
Twenty participants from the general population (male = 8; female = 12) and 21 participants with SMI (male = 10; female = 11) participated in the study (Table 1). Nineteen from the 20 participants of the general population and 9 from the 21 participants with SMI were employed. Participants from the general population were recruited through distributing an email within the local university system and through community shop owners known to the researcher. Participants currently experiencing a mental illness were recruited through support workers from two local community mental health organisations, who provided support with recruitment.
Participants were required to be 18 years or older and be able to provide informed consent. Participants currently experiencing a mental illness had to have a current Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association 1994) diagnosis of one of the following: schizophrenia, manic depressive disorder, bipolar disorder, affective, anxiety and substance dependence disorders, personality disorders, psychosis, schizoaffective disorder or depression, and be involved with either mental health organisation. …