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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 28-32

Risk behaviors leading to physical health among youth having psychiatric disorders


1 PG student-M Sc in Psychiatric Nursing, Father Muller College of Nursing, Mangalore, Karnataka, India
2 Professor & HOD, Department of Mental Health Nursing, Father Muller College of Nursing, Mangalore, Karnataka, India

Date of Web Publication10-Jul-2019

Correspondence Address:
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-1505.262502

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  Abstract 


Background: People with psychotic illnesses, have high rates of unhealthy lifestyle factors, such as smoking and physical inactivity. The consequences of such risk behaviors can lead to COPD, Cancer, HTN, CAD, obesity, liver cirrhosis, cardiomyopathy, infertility, HIV and sexually transmitted diseases. The risk for unhealthy life styles is high among young people with psychiatric disorders. The main objective of the study was to assess the physical health risk behaviors in young people with psychiatric disorders. Materials and methods: The data was collected from 62 psychiatric patients recruited by purposive sampling technique from psychiatric wards and OPD and Physical Health Risk Behavior Questionnaire was administered by interview technique. Results: The study findings showed that physical health risk behaviors in young people with psychiatric disorders was low (12.5 ? 6.80). There was significant association between physical health risk behaviors and gender (p=0.001). Conclusion: It is the need of the hour to assess various physical health risk behaviors found in patients with psychiatric disorders to intervene effectively so as to improve the quality of life of the patients and thus contribute to better quality of care received by patients.

Keywords: Physical health risk behaviors; psychiatric disorders; young people


How to cite this article:
Joy H, Jose AE. Risk behaviors leading to physical health among youth having psychiatric disorders. Indian J Psy Nsg 2018;15:28-32

How to cite this URL:
Joy H, Jose AE. Risk behaviors leading to physical health among youth having psychiatric disorders. Indian J Psy Nsg [serial online] 2018 [cited 2022 Oct 6];15:28-32. Available from: https://www.ijpn.in/text.asp?2018/15/1/28/262502




  Introduction Top


Mental health problems affect society as a whole and not just a small, isolated segment. It is therefore a major challenge to global development. No group is immune to mental disorders, but the risk is higher among the poor, homeless unemployed persons with low education, victims of violence, migrants and refugees, indigenous population children and adolescents, abused women and the neglected elderly. According to systematic analysis for the Global Burden of Disease Study 2010, the largest contributor to global years Lived with Disabilities (YLD) was mental and behavioral disorders. Mental and behavioral disorders accounted for 22.7% of all YLDs[1]. According to WHO statistics 5% of the population lives with mental illness which translates to over 50 million people. 6% of Kerala’s population has mental disorders and 1 in 5 have emotional and behavioral problems, ranging from mild to severe. Depression the most prevalent form of mental illness is estimated to exist in 3 of every 100 in urban areas like Mumbai[2] .

People with mental illness have the right to good health and a life expectancy equal to the general population. Yet epidemiological data and the lived experiences of those affected by mental illness clearly demonstrate significant discrepancies[3].People diagnosed with mental illness have elevated risk of preventable chronic physical illnesses and reduced life expectancy of up to 30 years[4]. Psychotropic medications typically prescribed in mental health services are identified as contributing to higher rates of physical illness, particularly cardio metabolic disorders. Together with the unwanted side effects of antipsychotic medication, this increased morbidity is partly due to adverse life style factors or risk behaviors, including tobacco use, poor diet and physical inactivity. Co- occurring physical and mental illness are also found to vary with socio-economic deprivation such as low income or unemployment, and risk factor behaviors such as alcohol misuse, smoking, high sugar food consumption and physical inactivity[5].

A meta- analysis conducted in May 2013, in young adult males (17-35 yrs) of college showed risk behaviors such as physical inactivity (27%), alcohol use (25%), unsafe sexual behaviors (21%), poor diet (5%), unsafe vehicle driving (5%) and recreational drug use (2%)[6]. Another study conducted to assess the high prevalence of poor physical health and unhealthy lifestyle behaviors in individuals with severe mental illness showed the prevalence of obesity, metabolic syndrome, Diabetes mellitus, symptoms of cardiovascular disease, respiratory diseases all exceeding that of the general population by at least 2 times and HIV prevalence by eight times.

A nationally representative face to face household survey carried out from October 2003 to December 2004 with 12, 992 participants aged 16 years and over showed people with mental disorder relative to those without mental disorder, had higher prevalence of several chronic physical conditions (cardiovascular disease, high blood pressure and respiratory conditions) and chronic condition risk factors ( smoking, obesity and alcohol use)[7]. A cohort study conducted in London from 2005-15 in patients aged >30 yrs showed that patients with psychiatric disorders had an increased risk for cardiovascular risk factors especially diabetes, hyperlipidemia and obesity[8].

In India studies conducted on physical health risk behaviors in young people with psychiatric disorders are very few. Considering the early onset and chronic nature of the illness it is important to assess the health risk behaviors of young people with psychiatric disorders.


  Materials and methods Top


A descriptive cross sectional study design was used for the study. Ethical clearance was obtained from Father Muller Institutional Ethics Committee. Formal written permission was obtained from the concerned authorities to conduct the research study in the selected hospital, Mangalore. The study was conducted in the psychiatric wards and OPD, from 1/3/2017 to 1/4/2017. Sixty two subjects were selected by purposive sampling technique. Even if 80 young patients with psychiatric disorders were identified during data collection period, 18 patients did not give informed consent for the study. The inclusion criteria were as follows: 1) Male and female patients in the age group of 18-35 years 2) Patients who score more than 23 in mini mental status examination 3) Patients who can read and write Kannada Malayalam and English. The exclusion criteria included 1) Patients with substance abuse disorders 2) Patients with intellectual disability. The instruments used were baseline proforma, Physical Health Risk Behavior Questionnaire and Mini Mental State Examination (MMSE). The Mini Mental State Examination (MMSE) developed by Dr. Marshall Folstein in 1975 was used as a screening tool for selecting the patients. Those who scored more than 23 were selected for the study. Physical Health Risk Behavior Questionnaire was prepared by the researchers on the basis of Youth Risk Behaviour Survey (YRBS, 1991-2015). It consisted of 25 items, divided into 7 domains which included negligent driving, violent behavior, suicidal attempt, tobacco use, drinking alcohol, use of other drugs and physical inactivity. The scores of risk behaviors varied from 0-7. The maximum score was 98. The physical health risk behaviors were classified into high >59 (> 60%), moderate 29-59 (30-60%) and low <29 (< 30%). After construction, the tool was validated by eight experts from psychiatry and psychiatric nursing. The reliability of the tool was established by test-retest method and correlation coefficient was found to be 0.8. The participants took an average of 15-25 minutes to complete the responses. Statistical Analysis: Data was analyzed using SPSS version 21. The tests used were frequency, percentage, mean, median, standard deviation, mean percentage and chi square test.


  Results Top


Table 1: Frequency distribution of baseline characteristics young persons with psychiatric disorders n=62

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Distribution of subjects according to the level of Physical Health Risk Behaviors in young people with psychiatric disorders:

The 96.77% of the subjects had low physical health risk behaviors and 3.22% of the subjects had moderate physical health risk behaviors.

Physical Health Risk Behaviors:

The mean score of physical health risk behaviors was 12.5± 6.80 with a median of 11 which indicates low health risk behaviors among young patients

Table 2: Domain wise scores of physical health risk behaviors in young persons with psychiatric disorders. n=62

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The domain wise mean scores shows the low physical health risk behaviours of patients with psychiatric disorders

Association between physical health risk behaviors and selected baseline variables of young people with psychiatric disorders

A significant association was found between physical health risk behaviors and gender (p=0.001). The risk behaviors were high in males.

As given in [Table 3] that reveals that moderate risk was found in majority of subjects related to the behaviors of not wearing a seat belt when riding a car (59.67%), not getting involved in physical exercises (53.23%) and watching TV (51.61%).
Table 3: Item wise analysis of physical health risk behaviors young persons with psychiatric disorders n=62

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  Discussion Top


In the present study, majority of subjects (96.77%) had low physical health risk behaviors and 3.22% of them had moderate physical health risk behaviors. The mean score and SD of physical health risk behaviors in young people with psychiatric disorders was 12.5±6.88.

Inconsistent findings were observed in other studies where the prevalence of physical health risk behavours was reported to be high. In present study only physical health risk behaviours were studied, not the consequences of such behaviors and so the discussion in the context of such findings was not carried out.

Higher prevalence of several chronic physical conditions (cardiovascular disease, high blood pressure and respiratory conditions) and chronic condition risk factors ( smoking, obesity and alcohol use) were observed in a nationally representative face-to-face household survey carried out from October 2003 to December 2004 with 12, 992 participants aged 16 years and over with mental disorders[7]. A metaanalysis conducted from 1996 through April 2006, with the aim of comparing the use of cigarettes in individuals with mental illness and those without mental illness showed individuals with current mental illness are more than twice as likely to smoke cigarettes and more than 50% are more likely to be overweight/obese[9].

An exploratory study done in San Francisco, to examine the behavioral risk profiles of adults with Severe Mental Illnesses showed 693 adult smokers diagnosed with mood disorders (71%), substance use disorders (63%), post traumatic stress disorder (39%), psychotic disorders (25%) and attention deficit hyperactivity disorders (25%)10. A cohort study conducted in London from 2005-15 in patients aged >30 yrs showed that patients with psychiatric disorders had an increased risk for cardiovascular risk factors especially diabetes, hyperlipidemia and obesity[8].

Risky alcohol use was found in more than one third of patients and was more common in males (p <0.001) in a study done to examine the prevalence of risky use of alcohol, alcohol use disorder (AUD), smoking and nicotine use disorder in people with psychiatric diagnosis[11]. This was consistent with the present study findings where risky alcohol use was found more in males.

An exploratory study done in Caucasians to examine the behavioral risk profiles of adults with SMI showed that participants mostly were males and engaged in multiple risk behaviors namely, smoking (100%), high fat diet (68%), poor sleep (53%), physical inactivity (52%) and marijuana use (46%)[12]. Another study conducted among individuals with SMI showed the prevalence of obesity, metabolic syndrome, DM, symptoms of cardiovascular disease and respiratory disease exceeded that of the general population by at least 2 times and HIV prevalence by 8 times[5].

The probable reasons for the inconsistent study findings in the present study results may be as follows: patients may have been cautious in answering questions, there are chances that they might not have given honest and truthful responses for each item. Majority of the subjects in the study were well educated (Pre university and post graduates), thereby knowing the consequences of physical health risk behaviors. Presence of own family members along with them could have been a possible reason for not divulging the details about their risk behaviors. Another reason can be the exclusion of patients with a co-morbid substance abuse. Conclusion The physical health risk behaviors in young people with psychiatric disorders was very low. The domain wise distribution of physical health risk behaviors in young people with psychiatric disorders showed highest in the domain of physical inactivity whereas the lowest was in the domain of drug abuse. Significant association was found between physical health risk behaviors and gender. The study need to be conducted in various psychiatric settings on a larger representative sample before generalizing the findings

Conflict of interest: None.



 
  References Top

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Murray CJ. Disability Adjusted Life Years For 291 Diseases And Injuries In 21 Regions, 1990-2010: Systematic analysis for the Global Burden of Disease Study 2010: [Internet].2012 [cited 2017 May 10]; 380(9859): 2197-2223.  Back to cited text no. 1
    
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Mathur R,Ayis S, Robson J,Ayerbe L. Cardiovascular Risk Factors Among Patients With Schizophrenia, Bipolar Depressive, Anxiety And Personality Disorders. Eur Psychiatry [Internet] 2016 M a y ; 35:8-15 .Available from https://www.ncbi.nlm.nih.gov/pubmed/27061372.  Back to cited text no. 8
    
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Compton MT, Daumit GT, Druss BG. Cigarette Smoking And Overweight/Obesity Among Individuals With Serious Mental Illnesses: A Preventive Perspective. Harv Rev. Psychiatry. [Internet] .2006 Jul-Aug: 14(4): 212-22. Available from https://www.ncbi.nlm.nih.gov/pubmed/ 16912007  Back to cited text no. 9
    
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Bizzari JV, Casetti V, Panzani P, Mulas S, Briani A. Risky Use And Misu se Of AI cohol And Cig arettes In Psychiatri c In patients : A Screening Questionnaire Study. Compr Psychiatry [Internet] 2016 Oct; 70:9-16. Available from https://www.ncbi.nlm.nih.gov/pubmed/27624418.  Back to cited text no. 10
    
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Bizzari JV, Casetti V, Panzani P, Mulas S, Briani A. Risky Use And Misuse Of Alcohol And Cigarettes In Psychiatric Inpatients: A Screening Questionnaire Study. Compr Psychiatry [Internet] 2016 Oct; 70:9-16. Available from https://www.ncbi.nlm.nih.gov/pubmed/27624418.  Back to cited text no. 11
    
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Prochaska JJ, Fromont SC, Delucchi K. Multiple Risk- Behavior Profile Of Smokers With Severe Mental Illness And Motivation For Change. Health Psychol [Internet] 2014 Dec;33(12):1518-29.Available from https://www.ncbi.nlm.nih.gov/pubmed/24467257.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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