The effects of a multidisciplinary lifestyle-enhancing treatment for severe mentally ill inpatients (MULTI-study)

Abstract

Background The mortality gap of 13-30 years between severe mentally ill (SMI) patients and the general population is mainly caused by cardiovascular disease. Especially long-term inpatients are characterized by an unhealthy lifestyle, whereby they are sedentary (sitting/lying) for 84% of the time. However, in this severely ill population, changing lifestyle-behaviour is challenging. Therefore, we started a multidisciplinary lifestyle-enhancing treatment, based on a ‘change-from-within-principle’, and evaluated improvements in both physical and mental health and functioning after 18 months. Methods Quasi-experimental design in long-term SMI inpatients whose baseline data (2013) was available and if they participated in no other lifestyle-related intervention (N=123). We collected: - Physical activity (PA); accelerometer-measured during 5 days [ActiGraph GT3X+] - Metabolic risk factors [weight, abdominal girth (cm), blood-pressure and –levels] - Psychotic symptoms [PANSS-r] - Psychosocial functioning [HoNOS] - Quality of life (QoL) [EQ-5D & WHOQoL-Bref] Analysis: hierarchical multilevel regression using change-scores, correcting for baseline outcome-value, age, diagnosis, baseline illness-severity and treatment-ward. Findings Sufficient data of intervention (N=65) and controls (N=49), who differed in age, diagnosis and baseline illness-severity (p<0.01). Results show significant improvements in PA (B=0.5, p=0.02), weight (B=-4.2, p=0.04), abdominal girth (B=-3.5, p=0.03), systolic blood pressure (B=-8.0, p=0.02), HDL-cholesterol (B=0.1, p=0.03) and psychosocial functioning (B=-3.6, p=0.03). QoL improved significantly in both groups. Discussion - Results confirm that using existing resources and a multidisciplinary lifestyle-enhancing treatment, sustainable improvements in PA, metabolic risk, functioning and QoL can be achieved in long-term SMI inpatients. - No lifestyle-enhancing treatment = non-significant improvement (or deterioration) in outcomes, except for QoL.