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Using a multimethod, multiinformant longitudinal design, we examined associations between specific forms of positive and negative emotional reactivity at age 5, children’s effortful control (EC), emotion regulation, and social skills at age 7, and adolescent functioning across psychological, academic, and physical health domains at ages 15/16 (N = 383). We examined how distinct components of childhood emotional reactivity directly and indirectly predict domain-specific forms of adolescent adjustment, thereby identifying developmental pathways between specific types of emotional reactivity and adjustment above and beyond the propensity to express other forms of emotional reactivity. Age 5 high-intensity positivity was associated with lower age 7 EC and more adolescent risk-taking; age 5 low-intensity positivity was associated with better age 7 EC and adolescent cardiovascular health, providing evidence for the heterogeneity of positive emotional reactivity. Indirect effects indicated that children’s age 7 social skills partially explain several associations between age 5 fear and anger reactivity and adolescent adjustment. Moreover, age 5 anger reactivity, low-, and high-intensity positivity were associated with adolescent adjustment via age 7 EC. The findings from this interdisciplinary, long-term longitudinal study have significant implications for prevention and intervention work aiming to understand the role of emotional reactivity in the etiology of adjustment and psychopathology.
It is unclear what the prevalence of metabolic syndrome (MetS) in drug-naïve first-episode of psychosis (FEP) is, as previous meta-analyses were conducted in minimally exposed or drug-naïve FEP patients with psychotic disorder at any stage of the disease; thus, a meta-analysis examining MetS in naïve FEP compared with the general population is needed.
Studies on individuals with FEP defined as drug-naïve (0 days exposure to antipsychotics) were included to conduct a systematic review. A meta-analysis of proportions for the prevalence of MetS in antipsychotic-naïve patients was performed. Prevalence estimates and 95% CI were calculated using a random-effect model. Subgroup analyses and meta-regressions to identify sources and the amount of heterogeneity were also conducted.
The search yielded 4143 articles. After the removal of duplicates, 2473 abstracts and titles were screened. At the full-text stage, 112 were screened, 18 articles were included in a systematic review and 13 articles in the main statistical analysis. The prevalence of MetS in naïve (0 days) FEP is 13.2% (95% CI 8.7–19.0). Ethnicity accounted for 3% of the heterogeneity between studies, and diagnostic criteria used for MetS accounted for 7%. When compared with controls matched by sex and age, the odds ratio is 2.52 (95% CI 1.29–5.07; p = 0.007).
Our findings of increased rates of MetS in naïve FEP patients suggest that we are underestimating cardiovascular risk in this population, especially in those of non-Caucasian origin. Our findings support that altered metabolic parameters in FEPs are not exclusively due to antipsychotic treatments.
There is evidence of the effectiveness of multi-professional home treatment models with regards to improving mental health for elderly patients with mental illness. However, there is a lack of studies examining the efficacy with regard to physical health.
To explore the effectiveness of geropsychiatric home treatment for elderly patients with mental illness with regards to improving physical health by assessing the need of physical treatment.
A 1-year retrospective matched-pair cohort study was conducted in four regions of Austria. We compared 91 patients with a broad spectrum of mental disorders in geropsychiatric home treatment by 1:2 matching to 182 patients in treatment as usual regarding number of contacts with health services, prescriptions, hospital discharges and length of hospital stay.
Patients in geropsychiatric home treatment showed significantly lower numbers of consultations with general practitioners (P < 0.001) and specialists (internal medicine, P = 0.022; psychiatry, P < 0.001), and lower numbers of prescriptions (medical drugs except psychotropic drugs, P < 0.001; psychotropic drugs, P < 0.004) compared with patients in treatment as usual. However, there was no significant difference in the number of hospital discharges and length of hospital stays.
Geropsychiatric home treatment has a positive effect on mental and physical parameters, which is discussed in the context of stress reduction.
The familial financial situation and its perception can be an important factor in the subjective well-being of adolescents, affecting their physical health and psychological state.
To identify the correlation between the perception of the familial financial situation, the physical health and various aspects of the psychological state of adolescents were self-assessed.
The study involved 506 adolescents (217 males and 289 females) aged 14 to 18 years (M=16.46; SD=1.07). We analyzed the relationship between participants’ assessment of their family’s financial situation, its changes over the past three years, and the adolescents’ self-report on their physical health, stress experiences, and feelings of happiness.
Perception of the financial situation (r=0.316;p<0.001) and assessment of its changes (r=0.217;p<0.001) are directly related to the self-assessment of physical health for the entire sample, as well as separately for boys and girls. For the entire sample, there were no links between the perception of the financial situation and the experience of stress and happiness. However, the study of relationships with gender as an independent variable showed that in boys, the financial situation score is associated with feeling happy (r=0.189;p=0.005), and in girls, an inverse relationship was found between the perception of a worsening financial situation and the experience of stress (r=-0.242;p<0.001).
The perception of the financial situation by adolescents affects the self-assessment of physical health by both boys and girls, but affects different aspects of the psychological state, depending on gender. The research was supported by the Russian Science Foundation, with the grant 15-18-00109.
Severe mental disorders (SMD) are associated with higher morbidity rates and poorer health outcomes compared to the general population. They are more likely to be overweight, to be affected by cardiovascular diseases, and to have higher risk factors for chronic diseases.
To assess physical health in a sample of patients with SMD and to investigate which mental health-related factors and other psychosocial outcomes could be considered predictors of poor physical health.
Patients referring to the psychiatric outpatients unit of the University of Campania “L. Vanvitelli” were recruited, and were assessed through validated assessment instruments exploring psychopathological status, global functioning and stigma. Physical health was assessed with an ad-hoc anthropometric schedule. A blood sample has been collected to assess levels of cholesterol, blood glucose, triglycerides, and blood insulin.
75 patients have been recruited, with a mean age of 45.63±11.84 years. 30% of the sample had a diagnosis of psychosis, 27% of depression and 43% of bipolar disorder. A higher BMI is predicted by higher number of hospitalizations, a reduced score at MANSA (p<.000), and PSP (p<.05), and higher score at ISMI and BPRS (p<.05). A higher cardiovascular risk is predicted by a reduced MANSA score (p<.000), a higher ISMI score and a poorer adherence to pharmacological treatments (p<.05). Higher ISMI score (p<.0001) and number of hospitalizations (p<.05) are predictors of insulin-resistance.
Our study shows that psychosocial domains negatively influence physical health outcome. It is necessary to disseminate an integrated psychosocial intervention in order to improve patients’ physical health.
The bi-directional relationship between mental and physical illness is well established. Therefore, in order to lower the already high mortality rates associated with psychiatric disorders, physical health issues must be closely monitored in this population [1,2]. A recent Lancet commission highlights emerging strategies and recommendations for improvement of physical health outcomes in patients with chronic mental disorders. These strategies involve better integration of physical and mental health care, combined with broader implementation of lifestyle interventions to reduce elevated cardiometabolic risk and attenuate medication side-effects .
To assess psychiatrists’ confidence levels in physical healthcare competencies; to explore whether confidence was related to learning opportunities.
Physical healthcare learning objectives were extracted from the Irish College of Psychiatrists’ training curriculum. An electronic questionnaire was sent to 50 psychiatrists in one Irish healthcare region with a catchment area of c. 450,000. Participants had to rate confidence levels for each competency on a five-point Likert scale and the availability of learning opportunities for attaining each competency.
66% response rate was achieved. A majority reported confidence in cardiovascular examination, interpreting blood results and evaluating comorbidities. A minority reported confidence in interpreting imaging, electrocardiograms and recognising medical emergencies. This corresponds to a relative paucity of learning opportunities.
Clinical implication Programmes for trainee doctors and CME opportunities for consultant psychiatrists would benefit from an emphasis on physical health examination and modules on interpreting investigations and the recognition of medical emergencies.
Violent Experiences result in economic and social costs for society, impacting on emotions in families, on health (both physical and mental), and overall quality of life, causing potential damages. Thus, it becomes relevant to do research on this impact, aiming at raising awareness and promoting prevention.
The purpose of the study is to estimate the impact of experiences of violence on both physical and mental health taking into account variables such as age, gender, and marital status.
This is a cross-sectional study sampling 1407 Portuguese speaking adults, with an age average of 42 years old (DP=17.28). The measures used were: The SF-36 questionnaire to assess quality of life, physical and mental health, and the Experiences of Violence Questionnaire.
The sample was divided into two groups (victims and non-victims). The group of participants that were not subjected to violence presents more positive results. In relation to the comparison between genders, it was verified that males present more positive results having into account all dimensions SF-36 when compared to women. Also, older participants (53 years old or more) presents lower results of general health.
Violence and health, increasingly related due to the impact it has on the subjects’ physical and mental health and quality of life.
Research to-date has examined the impact of intergenerational support in terms of isolated types of support, or at one point in time, failing to provide strong evidence of the complex effect of support on older persons’ wellbeing. Using the Harmonised China Health and Retirement Longitudinal Study (2011, 2013 and 2015), this paper investigates the impact of older people's living arrangements and intergenerational support provision/receipt on their physical and psychological wellbeing, focusing on rural–urban differences. The results show that receiving economic support from one's adult children was a stronger predictor for higher life satisfaction among rural residents compared to urban residents, while grandchild care provision was an important determinant for poor life satisfaction only for urban residents. Having weekly in-person and distant contact with one's adult children reduced the risk of depression in both rural and urban residents. Older women were more likely than men to receive support and to have contact with adult children, but also to report poor functional status and depression. The paper shows that it is important to improve the level of public economic transfers and public social care towards vulnerable older people in rural areas, and more emphasis should be placed on improving the psychological wellbeing of urban older residents, such as with the early diagnosis of depression.
To examine whether national initiatives have led to improvements in the physical health of people with psychosis. Secondary analysis of a national audit of services for people with psychosis. Proportions of patients in ‘good health’ according to seven measures, and one composite measure derived from national standards, were compared between multiple rounds of data collection.
The proportion of patients in overall ‘good health’ under the care of ‘Early Intervention in Psychosis’ teams increased from 2014–2019, particularly for measures of smoking, alcohol and substance use. There was no overall change in the proportion of patients in overall ‘good health’ under the care of ‘Community Mental Health Teams’ from 2011–2017. However, there were improvements in alcohol use, blood glucose and lipid levels.
There have been modest improvements in the health of people with psychosis over the last nine years. Continuing efforts are required to translate these improvements into reductions in premature mortality.
To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students.
An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.
Twenty-two higher education institutions.
College students (n 17 686) enrolled at one of twenty-two participating universities.
Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04).
College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.
People affected by severe mental health disorders have a greatly reduced life expectancy compared to their non-affected peers. Cardiovascular disease is the main contributor to this early mortality, caused by higher rates of smoking, physical inactivity, unhealthy diet, sleep disturbance, excessive alcohol use or substance abuse and medication side effects. Therefore, we need to take a preventative approach and translate effective interventions for physical health into routine clinical practice. These interventions should be delivered across all stages of mental health disorders and could also have the added benefit of leading to improvements in mental health. Furthermore, we need to advocate to ensure that people affected by severe mental health disorders receive the appropriate medical assessments and treatments when indicated. This themed issue highlights that physical health is now an urgent priority for funding and development in mental health services. The widespread implementation of evidence-based interventions into routine clinical practice is an essential need for consideration by clinicians and policymakers.
Thriving at the intrapersonal level is about discovering a secure sense of self: of knowing who one is, but retaining the fluidity to respond and adapt as the world unfolds itself. Mental health challenges have become a major concern across the world. Many factors may be at work (exam stress, relationships, economic circumstances, poor sleep, diet) and these may also include separation from nature and the outdoors. Looking to the future, increasing automation of work and changes to the nature of careers poses further challenges as work has often conferred a sense of identity and purpose. Likewise, perpetual digital connection (while bringing benefits) curtails the space for silence and reflection, and risks an overload of information and choices. As with mental health, young people need the competencies to actively nurture their own physical health and fitness. Many physical health problems today arise from ignorance. The learning goals associated with this level of thriving are: learning responsibility for personal health, fitness and well-being; and attaining a secure sense of self and identity, with sources of personal nourishment and renewal.
There is a commonly observed association between chronic disease and psychological distress, but many potential factors could confound this association. This study investigated the association using a powerful twin study design that can control for unmeasured confounders that are shared between twins, including genetic and environmental factors. We used twin-paired cross-sectional data from the Adult Health and Lifestyle Questionnaire collected by Twins Research Australia from 2014 to 2017. Linear regression models fitted using maximum likelihood estimations (MLE) were used to test the association between self-reported chronic disease status and psychological distress, measured by the Kessler Psychological Distress Scale (K6). When comparing between twin pairs, having any chronic disease was associated with a 1.29 increase in K6 (95% CI: 0.91, 1.66; p < .001). When comparing twins within a pair, having any chronic disease was associated with a 0.36 increase in K6 (95% CI: 0.002, 0.71; p = .049). This within-pair estimate is of most interest as comparing twins within a pair naturally controls for shared factors such as genes, age and shared lived experiences. Whereas the between-pair estimate does not. The weaker effect found within pairs tells us that genetic and environmental factors shared between twins confounds the relationship between chronic disease and psychological distress. This suggests that associations found in unrelated samples may show exaggerated estimates.
As the coronavirus disease 2019 (COVID-19) epidemic in the UK emerged and escalated, clinicians working in mental health in-patient facilities faced unique medical, psychiatric and staffing challenges in managing and containing the impact of the virus and, in the context of legislation, enforcing social distancing.
To describe (a) the steps taken by one mental health hospital to establish a COVID-19 isolation ward for adult psychiatric in-patients and (b) how staff addressed the challenges that emerged over the period March to June 2020.
A descriptive study detailing the processes involved in changing the role of the ward and the measures taken to address the various challenges that arose. Brief clinical cases of two patients are included for illustrative purposes.
We describe the achievements, lessons learned and outcomes of the process of repurposing a mental health triage ward into a COVID-19 isolation facility, including the impact on staff. Flexibility, rapid problem-solving and close teamwork were essential. Some of the changes made will be sustained on the ward in our primary role as a triage ward.
Although the challenges faced were difficult, the legacy they have left is that of a range of improvements in patient care and the working environment.
Individuals with schizophrenia are at higher risk of physical illnesses, which are a major contributor to their 20-year reduced life expectancy. It is currently unknown what causes the increased risk of physical illness in schizophrenia.
To link genetic data from a clinically ascertained sample of individuals with schizophrenia to anonymised National Health Service (NHS) records. To assess (a) rates of physical illness in those with schizophrenia, and (b) whether physical illness in schizophrenia is associated with genetic liability.
We linked genetic data from a clinically ascertained sample of individuals with schizophrenia (Cardiff Cognition in Schizophrenia participants, n = 896) to anonymised NHS records held in the Secure Anonymised Information Linkage (SAIL) databank. Physical illnesses were defined from the General Practice Database and Patient Episode Database for Wales. Genetic liability for schizophrenia was indexed by (a) rare copy number variants (CNVs), and (b) polygenic risk scores.
Individuals with schizophrenia in SAIL had increased rates of epilepsy (standardised rate ratio (SRR) = 5.34), intellectual disability (SRR = 3.11), type 2 diabetes (SRR = 2.45), congenital disorders (SRR = 1.77), ischaemic heart disease (SRR = 1.57) and smoking (SRR = 1.44) in comparison with the general SAIL population. In those with schizophrenia, carrier status for schizophrenia-associated CNVs and neurodevelopmental disorder-associated CNVs was associated with height (P = 0.015–0.017), with carriers being 7.5–7.7 cm shorter than non-carriers. We did not find evidence that the increased rates of poor physical health outcomes in schizophrenia were associated with genetic liability for the disorder.
This study demonstrates the value of and potential for linking genetic data from clinically ascertained research studies to anonymised health records. The increased risk for physical illness in schizophrenia is not caused by genetic liability for the disorder.
Smartphones and associated wearable devices have gained a greater prominence directly within health psychology. Not only can such devices track health and answer a variety of research questions in relation to physical and mental health, but real-time feedback can also be augmented to support subsequent behaviour change interventions. There are literally 1000s of smartphone health apps that aim to change behaviour. Hence, health psychologists have been heavily involved with the design and testing of interventions (Ellis and Piwek, 2018). In addition, there are increasing numbers of interdisciplinary groups who focus on such interventions. However, while the research landscape is now littered with many well-publicised successes and failures, very little is known when it comes to understanding why such results are occurring even for users who engage with a long-term smartphone/wearable intervention. Despite having plenty of scope for development, progress has stalled because existing adaptations continue to be poorly designed from both a theoretical and patient perspective.
With these issues in mind, this chapter points towards where psychological research is using smartphone sensing methods that can quantify health related behaviours on a larger scale. It also considers how psychology can make a key contribution in the future. For example, while the process of behaviour change remains complex, additional research is urgently needed to understand how individuals, devices, and related technologies can be designed and implemented if interventions are to become widespread across healthcare systems in the future (Piwek et al., 2016; Ellis and Piwek, 2018)
This chapter is premised on the belief that ethical medical and mental healthcare require a social justice framework, one that takes as its principal stance that healthcare is a human right. Utilizing Ruger’s health capability paradigm, we consider how, both within the United States itself and globally, the engagement of a perspective of positive rights regarding health and healthcare is required when approaching how to best address social disparities and access to medical and mental health treatment. We first consider the health capability paradigm and how it conceptually frames, within a social justice perspective, the right to health and the provision of healthcare for children and youth. We next explore how this model can be considered within a discussion of how dual medical and mental healthcare is currently practiced in a context where patients referred and treated are from lower- to lower-middle-class socioeconomic status communities, and who utilize Medicaid as their primary source of insurance for healthcare. We focus specifically on the provision of forms of medical and mental healthcare that are often the least considered and subsequently unreimbursed by Medicaid, neuropsychological assessment and consultation/liaison for mental health. We next present a case that addresses the application of the health capability paradigm within a child and adolescent psychiatric care setting, and then end with a discussion of how communities, both locally and within the United States, can better engage this model as a means for justifying more equitable and conscientious care for children and adolescents.
Smoking rates among people with common mental health conditions remain around 50% higher than those in the wider population; this is a significant cause of the 10–20-year reduced life expectancy of people with mental health conditions. However, the effects of smoking go far beyond physical health. Research estimates that smokers with mental health conditions could be spending as much as £2200 a year on tobacco, pushing an estimated 130 000 people with a common mental disorder into poverty. The Government has set a target for England to be smokefree by 2030; however, without a dramatic increase in support, smokers with mental health conditions risk being left behind. Action on Smoking and Health provides the secretariat for the Mental Health & Smoking Partnership. The Partnership aims to reduce the inequality in smoking rates between people with mental health conditions and the wider population. It brings together Royal Colleges, third-sector organisations, trade unions and academia to review progress and highlight areas for further action.
Research has demonstrated that holding a young subjective age (i.e. feeling younger than one's chronological age) has been associated with various positive aspects of physical and psychological health. However, little is known about how such associations differ between cultural sub-groups within a given society. Accordingly, the current study focused on the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) and aimed to explore the moderating role of culture on the association between subjective age and objective physical health, subjective physical health and psychological health. Data were collected from 1,793 respondents, who were classified into three groups: veteran Israeli Jews, immigrants from the former Soviet Union and Israeli Arab citizens. Age ranged from 50 to 105 (mean = 69.65, standard deviation = 9.49). All participants rated their subjective age and filled out scales examining six dimensions covering psychological health, as well as objective and subjective physical health. Across all examined dimensions, an older subjective age was associated with unfavourable health outcomes. For the majority of health dimensions, the subjective age–health links were most prominent among Israeli Arabs. Results are discussed from both a general societal standpoint (i.e. group differences in access to health services), as well as from the individual's specific role in his or her culture and society.
Keeping children safe in Australian education settings is a priority. In 2012, the National Quality Standards were implemented for early childhood education and care throughout Australia. Standard 2 relates to children’s health and safety. It encompasses children’s physical health and comfort, healthy eating and physical activity, and safety and protection from harm. A safe environment for a child is one that provides freedom from harm and offers a strong sense of security and belonging from which to play, learn and develop. A healthy and safe environment also promotes children’s psychological wellbeing by allowing them to exercise their independence through making decisions and taking on new challenges. Educators are responsible for providing and maintaining safe environments for children in their care, including the development of strategies to prevent injury in indoor and outdoor environments. Injury prevention promotes safety, protects the child and minimises risk. By protecting children from hazards, injury prevention offers children the sense of safety and security that allows them to develop to their fullest potential.