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People with intellectual disability have a higher rate of mortality and morbidity. Prescribing medication requires regular physical monitoring to ensure that the person with intellectual disability is not put at additional risk of health problems. The chapter provides details of necessary testing.
Physical health conditions are more common in individuals with autism. Some, like epilepsy, have considerable evidence supporting their increased prevalence, but many diseases lack literature to make strong conclusions.
Aims
To investigate the prevalence of physical health comorbidities in autism.
Method
We undertook a nested cross-sectional study, using a sample from the National Centre for Mental Health database. It included participants from England and Wales who reported a clinician-made diagnosis of autism (n = 813), and a control sample without autism or mental illness (n = 2781). Participants had provided a medical history at enrolment. Analysis was carried out by binomial logistic regressions controlling for age, gender, smoking status, and antipsychotic and mood stabiliser use. A subanalysis of individuals with concurrent intellectual disability (n = 86) used binomial logistic regression with the same control variables.
Results
Many physical health conditions were significantly more common in autism. Sixteen out of 28 conditions showed increased odds, with the highest odds ratios observed for liver disease, chronic obstructive pulmonary disease, kidney disease, osteoporosis and rheumatoid arthritis. A subanalysis demonstrated a similar pattern of physical health in individuals with autism with and without concurrent intellectual disability. Some conditions, including osteoporosis, hyperthyroidism, head injury and liver disease, had larger odds ratios in individuals with concurrent intellectual disability.
Conclusions
Physical health conditions occur more commonly in individuals with autism, and certain conditions are further increased in those with concurrent intellectual disability. Our findings contribute to prior evidence, including novel associations, and suggest that people with autism are at greater risk of physical health problems throughout adulthood.
Climate change is no longer a problem for future generations and the impact is already taking a toll in many parts of the world. Climate change has already caused substantial, and increasingly irreversible, damage to ecosystems. All these issues combined will inevitably lead to an increase in human suffering and forced displacement. This has significant ramifications for health care systems. In this editorial we outline how climate change is already impacting both physical and mental health. Health professionals have a role to play in addressing this great challenge of our time. Health professionals should reflect on how to promote means of climate change mitigation and adaptation within their spheres of influence – clinical, education, advocacy, administration, and research.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
This chapter emphasises the importance of the physical health history to holistic psychiatric case assessment. It describes the general approach to this and sets this particularly in the context of patients with serious or severe mental illness. Such patients have substantially increased morbidity and mortality from physical causes compared to the general population, and this increased mortality has been clearly documented for nearly two hundred years. A practical, collaborative and optimistic multilevel approach to attempting to make a difference to these outcomes is described, concluding with fourteen broad, practical areas for achievable interventions.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
This chapter covers psychosocial and physical health approaches to the management of bipolar disorder. These include psychosocial and physical health approaches to the condition that should be offered by every psychiatrist, as well as specialist psychological treatments delivered by psychological therapists. The approach outlined is supported by the National Institute for Care Excellence (NICE) in its 2014 clinical guideline for bipolar disorder as well as other clinical guidelines for bipolar disorder more recently published from Canada, Australia and New Zealand. Overall, the current best standard of practice for bipolar disorder is to adopt a collaborative proactive holistic approach attending to both mental health and physical health stability without the use of unnecessarily high doses of medication, particularly when they may impact on physical health. The approach should be consistent with the life goals and wishes of the person with bipolar disorder, convey a message of hope, and consider lifestyle and cognitive factors alongside symptoms and function. Bipolar disorder is a long-term condition where there is a potential for normal function and a high quality of life for many. A psychologically informed approach to management enables people with bipolar disorder to be proactive in their care, practice self-management and do their best.
A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.
Methods
We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t0;2006/2008 to t1;2010/2012) were associated with subsequent loneliness 4 years later (t2;2014/2016).
Results
Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.
Conclusions
Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.
Resilience research has long sought to understand how factors at the child, family, school, community, and societal levels shape adaptation in the face of adversities such as poverty and war. In this article we reflect on three themes that may prove to be useful for future resilience research. First is the idea that mental and physical health can sometimes diverge, even in response to the same social process. A better understanding of explanations for this divergence will have both theoretical and public health implications when it comes to efforts to promote resilience. Second is that more recent models of stress suggest that stress can accelerate aging. Thus, we suggest that research on resilience may need to also consider how resilience strategies may need to be developed in an accelerated fashion to be effective. Third, we suggest that if psychological resilience interventions can be conducted in conjunction with efforts to enact system-level changes targeted at adversities, this may synergize the impact that any single intervention can have, creating a more coordinated and effective set of approaches for promoting resilience in young people who confront adversity in life.
Lifestyle interventions are important to improve the mental and physical health outcomes of people with mental illness. However, referring patients to lifestyle interventions is still not a common practice for mental healthcare professionals (MHCPs) and their own lifestyle habits may impact this. The aim of this study was to investigate MHCPs’ personal lifestyle habits, their lifestyle history and referral practices, and if these are associated with their lifestyle habits, gender, and profession.
Methods
In this cross-sectional study, an online questionnaire was distributed across relevant MHCP’s in The Netherlands. Ordinal regression analyses on lifestyle habits, gender, profession, and lifestyle history and referral practices were conducted.
Results
A total of the 1,607 included MHCPs, 87.6% finds that lifestyle should be part of every psychiatric treatment, but depending on which lifestyle factor, 55.1–84.0% take a lifestyle history, 29.7–41.1% refer to interventions, and less than half (44.2%) of smoking patients are advised to quit. MHCPs who find their lifestyle important, who are physically more active, females, and MHCPs with a nursing background take more lifestyle histories and refer more often. Compared to current smokers, MHCPs who never or formerly smoked have higher odds (2.64 and 3.40, respectively, p < 0.001) to advice patients to quit smoking.
Conclusions
This study indicates that MHCPs’ personal lifestyle habits, gender, and profession affect their clinical lifestyle practices, and thereby the translation of compelling evidence on lifestyle psychiatry to improved healthcare for patients.
Three factors converge to underscore the heightened importance of evaluating the potential health/well-being effects of friendships in older adulthood. First, policymakers, scientists, and the public alike are recognizing the importance of social relationships for health/well-being and creating national policies to promote social connection. Second, many populations are rapidly aging throughout the world. Third, we currently face what some call a ‘friendship recession’. Although, growing research documents associations between friendship with better health and well-being, friendship can also have a ‘dark side’ and can potentially promote negative outcomes. To better capture friendship’s potential heterogeneous effects, we took an outcome-wide analytic approach.
Methods
We analysed data from 12,998 participants in the Health and Retirement Study (HRS) – a prospective and nationally representative cohort of U.S. adults aged >50, and, evaluated if increases in friendship strength (between t0; 2006/2008 and t1; 2010/2012) were associated with better health/well-being across 35 outcomes (in t2; 2014/2016). To assess friendship strength, we leveraged all available friendship items in HRS and created a composite ‘friendship score’ that assessed the following three domains: (1) friendship network size, (2) friendship network contact frequency and (3) friendship network quality.
Results
Stronger friendships were associated with better outcomes on some indicators of physical health (e.g. reduced risk of mortality), health behaviours (e.g. increased physical activity) and nearly all psychosocial indicators (e.g. higher positive affect and mastery, as well as lower negative affect and risk of depression). Friendship was also associated with increased likelihood of smoking and heavy drinking (although the latter association with heavy drinking did not reach conventional levels of statistical significance).
Conclusions
Our findings indicate that stronger friendships can have a dual impact on health and well-being. While stronger friendships appear to mainly promote a range of health and well-being outcomes, stronger friendships might also promote negative outcomes. Additional research is needed, and any future friendship interventions and policies that aim to enhance outcomes should focus on how to amplify positive outcomes while mitigating harmful ones.
Adult women of reproductive age are highly engaged with social media, suggesting its utility for conveying health information to this population, at scale. This scoping review aimed to describe health promotion interventions conducted via social media and assess their effectiveness to improve health outcomes, engagement and acceptability in adult women of reproductive age.
Design:
Six databases were searched on 13 May 2022. Two reviewers independently screened studies. Data were extracted and risk of bias assessed using the Joanna Briggs Critical Appraisal Tools.
Setting:
Eligible studies conducted an intervention primarily via social media, with or without a comparison intervention, and reported health-related outcomes/behaviours pre- and post-intervention. Results were presented in narrative form.
Participants:
Adult women (mean age 18–45 years).
Results:
Nine eligible studies were identified: six randomised control trials, two quasi-experimental studies and one cross-sectional study. Interventions focused on prenatal, antenatal or postpartum health or physical activity. Seven studies utilised Facebook for intervention delivery, one conducted a digital campaign across four platforms and one used WeChat. Studies reported significant improvements in a range of outcomes, including increased parenting competence, longer duration of breast-feeding and higher rates of physical activity. Social media interventions had greater engagement than control interventions.
Conclusions:
We identified nine diverse health promotion interventions conducted via social media, which appear acceptable and effective for improving various health outcomes in adult women of reproductive age. While this supports the utility of social media to convey health information, further research is required to prove effectiveness and superiority over other intervention strategies.
Since the 1970s, the association between social relationships and health status has been observed using a variety of measures. It is, however, still rare to obtain a dataset that contains detailed information on everyday social networks and that measures social relationships quantitatively for various statistical analyses. In conjunction with the National Social Life, Health, and Aging Project (NSHAP), the Korea Social Life, Health, and Aging Project (KSHAP) is a longitudinal study of health and social factors among older adults in South Korea. Since its inception in 2012, the KSHAP has been an interdisciplinary project involving studies spanning the disciplines of sociology, psychology, psychiatry, medicine, and social work. To date, there are five waves of social network data for village K and one wave for village L. This chapter describes, compares, and discusses the social lives and health of older adults in Korea and the United States by utilizing various social network dimensions and measures of older adults from the KSHAP and NSHAP studies to find common as well as unique pathways in aging in the two countries.
This chapter discusses the direct effects of racial discrimination on Black Americans’ health. It begins by documenting that daily exposure to the various forms of racial discrimination is a common experience for Black people living in the United States. Encountering racial discrimination creates stress, which activates physiological stress responses – bodily systems that normally provide person with the energy needed to rapidly reduce the stress. However, the stress created by racial discrimination is usually chronic because many Black Americans repeatedly experience racial discrimination over a prolonged period of time. When the bodily systems activated by stress response remain active, it creates a harmful physical condition – allostatic overload. Allostatic overload is responsible for a host of physical illnesses, including heart diseases, diabetes, and immune disorders. It is also associated with poorer mental health, as well as alterations in epigenetics, such as premature aging. Chronic stress can also cause people to engage in behaviors that may provide short-term emotional relief from discrimination-related stress but are unhealthy, such as drug use or eating certain unhealthy “comfort” foods. In sum, prolonged exposure to racial discrimination is a chronic stressor that threatens the health of Black Americans.
There are high levels of nutritional and metabolic, cardiovascular, and respiratory tract diseases among people diagnosed with serious mental illness (SMI). Consequently, we developed a pragmatic, affordable nutritional and exercise intervention: Choices4Health. Due to the COVID-19 pandemic, we modified this intervention so it could be delivered online. The aim of this study was to explore the experience of participating in online Choices4Health, in a real-world clinical setting, from the perspectives of service users with SMI.
Methods:
The study aim was addressed using thematic analysis. Service users who had attended online Choices4Health, received a SMI diagnosis (defined as a schizophrenia spectrum disorder or an affective disorder), and resided in a South Dublin catchment were invited to participate. Nine participants were purposefully sampled. Semi-structured interviews were conducted by telephone. Data analysis was guided by thematic analysis procedures.
Results:
Six themes were generated: Being ready and not overburdened (Engagement); Gaining knowledge and implementing it (Learning and doing); Viewing the intervention as appropriate and effective (Targeted impact); Being at home with others online (Belonging); Having a positive affective attitude towards the intervention (Feeling); and Perceiving problems with intervention delivery (Recommended change).
Conclusions:
Findings suggest that online Choices4Health is, broadly speaking, acceptable from a service user perspective, but that further refinement is required to address specific issues participants identified. These relate to follow-up or programme extension, technology access, in-person contact preference, and participant inclusion criteria. Further research is required into online Choices4Health efficacy, innovations to reduce digital exclusion, and managing group dynamics in telehealth interventions.
Severity of personality disorder is an important determinant of future health. However, this key prognostic variable is not captured in routine clinical practice. Using a large clinical data-set, we explored the predictive validity of items from the Health of Nation Outcome Scales (HoNOS) as potential indicators of personality disorder severity. For 6912 patients with a personality disorder diagnosis, we examined associations between HoNOS items relating to core personality disorder symptoms (self-harm, difficulty in interpersonal relationships, performance of occupational and social roles, and agitation and aggression) and future health service use. Compared with those with no self-harm problem, the total healthcare cost was 2.74 times higher (95% CI 1.66–4.52; P < 0.001) for individuals with severe to very severe self-harm problems. Other HoNOS items did not demonstrate clear patterns of association with service costs. Self-harm may be a robust indicator of the severity of personality disorder, but further replication work is required.
For reasons of human health and sustainability, there is a growing interest in the potential of integrated nature-based interventions in healthcare. However, it is not clear which quality criteria underlie these interventions. Here, we develop a study protocol for a scoping review to explore potential quality criteria relating to the design, implementation and evaluation of nature-based interventions in healthcare institutions. The literature search will be conducted in PubMed, MEDLINE, Web of Science and Scopus, focusing on studies published in English between January 2005 and April 2023. The Joanna Briggs Institute Scoping Review methodology and Preferred Reporting Items for Systematic Reviews with extension for scoping reviews will be used. Search terms were developed stepwise and in consultation with the interdisciplinary research team and the project steering group. Two researchers will perform the screening of the papers independently. Using descriptive content analysis, identified quality criteria will be classified according to the applied theoretical frameworks, outcomes, levels (institutional, professional and patient) and the domains of biodiversity, human health or intervention processes. Ultimately, this descriptive work will result in a set of quality indicators and a prototype nature-based intervention quality assessment framework, which will be presented to the project steering group and multi-stakeholder assembly for further refinement.
Eye movement desensitisation and reprocessing (EMDR) is a psychological therapy that addresses trauma, stress and emotional distress. It has been successfully used in the management of various psychiatric disorders. This article shows that it may also be safely used to manage the psychological distress arising from a variety of physical health conditions and in so doing, reduce the illness burden from conditions such as various cancers, traumatic childbirth, tokophobia, pre-eclampsia, myocardial infarction, haemodialysis in end-stage renal disease, and acute postoperative pain. It can be a stand-alone treatment for hyperemesis gravidarum and tinnitus. The article examines the rationale and evidence for its use in these conditions and suggests areas where more research is needed. Adding EMDR therapy to the range of available interventions in general hospitals has the potential to improve the health and well-being of patients in these settings.
Drawing on public health and psychological research and scholarship, we provide an overview of the historical, social, political, and economic experiences that impact the mental health and wellness of Black women in America. We explore Black women’s statuses driven by racial, ethnic, sex/gender, social class, and other disparities. Using a social determinants of health framework We highlight the ways that systemic inequities interact with biological predispositions to shape Black women’s health and mental health. We discuss how Black women’s social group statuses create challenging conditions that induce mental and emotional symptoms such as mood and anxiety disorders. We utilize a case example to illustrate how these interacting forces might play out in one Black woman’s life.
This study investigated, and discusses the integration of, the shift-and-persist (SAP) and skin-deep resilience (SDR) theories. The SAP theory states that the combination of shifting (adjusting oneself to stressful situations through strategies like emotion regulation) and persisting (enduring adversity with strength by finding meaning and maintaining optimism) will be beneficial to physical health in children experiencing adversity. The SDR theory states that high striving/self-control will be beneficial to mental health but detrimental to physical health among those confronting adversity. This study investigated 308 children ages 8–17 experiencing the adversity of a chronic illness (asthma). SAP and SDR (striving/self-control) were assessed via questionnaires, and physical health (asthma symptoms, inflammatory profiles), mental health (anxiety/depression, emotional functioning), and behavioral (medication adherence, activity limitations, collaborative relationships with providers) outcomes were measured cross-sectionally. SAP was associated with better physical health, whereas SDR was associated with worse physical health. Both were associated with better mental health. Only SDR was associated with better behavioral outcomes. Implications of findings and discussion of how to integrate these theories are provided. We suggest that future interventions might seek to cultivate both SAP and SDR to promote overall better health and well-being across multiple domains in children experiencing adversity.
We first tested a successful aging model, which included biomedical and psychosocial indicators. Next, we tested the assumptions on the social network characteristics of the socioemotional selectivity theory in a model where the outcome variable is successful aging.
Design:
Cross-sectional study.
Setting:
The study was carried out in municipal centers and nursing homes.
Participants:
A total of 478 adults (Mean age = 72.11, SD = 10.43) were enrolled.
Measurements:
Psychological Well-being Scale, Life Satisfaction Scale, Future Time Perspective, Katz Index of Independence in Activities of Daily Living Scale, Lawton Instrumental Activities of Daily Living Scale, and Mini-Mental State Examination Test were completed.
Results:
The structural equation modeling analyses indicated that higher social satisfaction mediated the association of the future time perspective with successful aging. Furthermore, there was another significant indirect sequential path from the future time perspective to successful aging. The path was first via the number of close social partners and second, social satisfaction.
Conclusions:
The findings highlight the importance of social satisfaction in the process of successful aging and provide novel evidence that the socioemotional selectivity theory can be considered as a biopsychosocial model of successful aging in future studies.
People with severe mental illness (SMI) have more physical health conditions than the general population, resulting in higher rates of hospitalisations and mortality. In this study, we aimed to determine the rate of emergency and planned physical health hospitalisations in those with SMI, compared to matched comparators, and to investigate how these rates differ by SMI diagnosis.
Methods
We used Clinical Practice Research DataLink Gold and Aurum databases to identify 20,668 patients in England diagnosed with SMI between January 2000 and March 2016, with linked hospital records in Hospital Episode Statistics. Patients were matched with up to four patients without SMI. Primary outcomes were emergency and planned physical health admissions. Avoidable (ambulatory care sensitive) admissions and emergency admissions for accidents, injuries and substance misuse were secondary outcomes. We performed negative binomial regression, adjusted for clinical and demographic variables, stratified by SMI diagnosis.
Results
Emergency physical health (aIRR:2.33; 95% CI 2.22–2.46) and avoidable (aIRR:2.88; 95% CI 2.60–3.19) admissions were higher in patients with SMI than comparators. Emergency admission rates did not differ by SMI diagnosis. Planned physical health admissions were lower in schizophrenia (aIRR:0.80; 95% CI 0.72–0.90) and higher in bipolar disorder (aIRR:1.33; 95% CI 1.24–1.43). Accident, injury and substance misuse emergency admissions were particularly high in the year after SMI diagnosis (aIRR: 6.18; 95% CI 5.46–6.98).
Conclusion
We found twice the incidence of emergency physical health admissions in patients with SMI compared to those without SMI. Avoidable admissions were particularly elevated, suggesting interventions in community settings could reduce hospitalisations. Importantly, we found underutilisation of planned inpatient care in patients with schizophrenia. Interventions are required to ensure appropriate healthcare use, and optimal diagnosis and treatment of physical health conditions in people with SMI, to reduce the mortality gap due to physical illness.