Independence through community access and navigation: A supported leisure intervention for individuals with negative symptoms.

OBJECTIVE: Promoting leisure participation requires a collaborative approach that emphasizes personal interests, strengths, and motivations. The purpose of this article was to test the effectiveness of the Independence through Community Access and Navigation (ICAN) intervention on community participation, recreation participation, and positive emotions among individuals with schizophrenia spectrum disorders. Using motivational interviewing and an individualized placements and support framework, the ICAN intervention focuses on working with participants to identify and participate in personally meaningful leisure activities by connecting with personal motivations and mainstream community opportunities. METHOD: This randomized controlled trial was conducted with 74 participants diagnosed with schizophrenia with assessments conducted at baseline and posttreatment. Intervention effects were examined with repeated-measures analysis of variance (ANOVA). Multiple regression analysis was also performed using a change score as an outcome variable and baseline negative symptoms score, condition, and interaction as predictors. RESULTS: There was no significant main effect of ICAN on positive emotions, recreation participation, or community participation; however, among those in the experimental group, those with impairments in motivation and pleasure experienced improvements in community participation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: For individuals experiencing greater negative symptoms, a supported leisure intervention may be an effective strategy to explore personal motivations and increase leisure participation. Future research should test the intervention effectiveness specifically targeting a larger sample of individuals with more severe negative symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Role of Acceptance in Everyday Loneliness Among Adults with Serious Mental Illness.

There is a high prevalence of loneliness among adults with serious mental illness (SMI) with most research focusing on stable contributing factors. This study sought to identify the role of dispositional loneliness and internalized stigma, as well as the momentary feelings of acceptance on experiential loneliness among adults with SMI. Data were collected using ecological momentary assessment via smart phones, and 89 adults with a SMI were included. Hierarchical linear modeling was used to identify the role of dispositional and experience factors in experiential loneliness. Findings indicated that (a) dispositional internalized stigma, (b) being at home, (c) being alone and, (d) a cross-level interaction between dispositional loneliness and feelings of acceptance best fit the data. The relationship of acceptance to experiential loneliness was strongest among the most lonely. Supporting people with SMI to develop social connections contributing to their relational value may enhance feelings of acceptance and reduce loneliness.

Participation in arts and culture among individuals with serious mental illnesses and its relationship to quality of life and recovery.

OBJECTIVE: Engagement in arts and cultural activities is valued and yields positive outcomes but may be understudied in populations with serious mental illness (SMI). Our aims are to evaluate the extent to which individuals with SMI deem participation areas related to arts and culture (e.g., going to a theater) to be important, and if important, how often they are being done and if it is enough in comparison to a nonSMI sample. METHODS: We conducted analyses using a sample of 1,120 individuals with SMI from nine research studies between 2008 and 2016 and a sample of 300 individuals without SMI that were part of the Truven Health Analytics PULSE survey. All participants completed a survey containing questions related community participation. Analyses were conducted using independent samples t tests, followed by analysis of variances, and chi-square tests. RESULTS: The results indicate that adults with SMI are as, or more interested in arts and cultural activities as adults in the general population, but do not participate in those areas as much as they would like in comparison. We also found that, as with the general population, participation in these areas is positively associated with quality of life and to a lesser degree, recovery. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Engagement in arts and culture activities may be an overlooked compared to other areas of participation, such as employment. Psychiatric rehabilitation practitioners may need to pay greater attention to areas related to art appreciation, rather than just art production. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Housing and loneliness among individuals with serious mental illnesses.

BACKGROUND: People with serious mental illnesses (SMI) have higher levels of loneliness than the general population. Furthermore, people with SMI tend to be less satisfied with their housing and tend to move more frequently. AIM: This study aims to examine relationships between housing variables (whom they live with, duration of residence, and satisfaction) and loneliness among individuals with SMI. METHODS: Data were collected from 188 adults with SMI in greater Philadelphia area. Classification and Regression Trees (CART) were used to examine whether whom they live with, duration of residence, and housing satisfaction were associated with loneliness. RESULTS: Housing satisfaction was found to be the most prominent predictor of loneliness. Those who were unsatisfied with their overall housing conditions always had the highest level of loneliness, regardless of other factors. Even if they were satisfied with their housing conditions, their loneliness was higher if they had just moved to the new residence. Participants had lower loneliness the longer they lived in a residence and had the lowest loneliness levels after about three years. CONCLUSION: Housing is associated with loneliness among people with SMI. Psychiatric service providers should increase support to factors contributing to housing satisfaction and duration of residence, including active engagement in the community.

Getting out of the house: The relationship of venturing into the community and neurocognition among adults with serious mental illness.

[Correction Notice: An Erratum for this article was reported online in Psychiatric Rehabilitation Journal on May 20 2021 (see record 2021-48272-001). In the original article, the following acknowledgments were missing from the author note: : "The contents of this article were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; Grant 901F0065-02-00; Mark S. Salzer, principal investigator). However, the contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and endorsement by the federal government should not be assumed. The authors are grateful to Kevin Frech, Stephany Wilson, Alison Weigl, Jared Pryor, David Glogoza and Katie Pizziketti for their assistance with data collection and analysis and to Alex Fechner for providing his implementation of the ST-DBSCAN algorithm in RapidMiner." All versions of the original article have been corrected.] Objective: The purpose of this study was to determine if environmental novelty was associated with neurocognitive function among adults with serious mental illness. Method: Participants were recruited from community mental health centers (n = 117), and received a Global Positioning System (GPS) enabled cellular phone for 13 days. Data were also collected on cognitive function and recent participation in community-based activities. Independent samples t-tests were conducted to identify differences in neurocognitive function between participants who predominantly stayed in their homes ("homebodies") versus those who ventured more often from their homes ("venturers"). Analyses were also undertaken to identify if the nature of community participation activities mediated the relationship of neurocognitive function to group membership. Results: Overall, 74% of GPS signals were from participants' home residence. Homebodies demonstrated significantly poorer cognitive function than venturers, and this relationship was not mediated by a number of unique destinations or breadth of community participation activities. Conclusions and Implications for Practice: This study identified a subset of adults with serious mental illnesses who left their homes infrequently and who demonstrate significantly poorer cognitive function than those who left their homes more frequently. Spending extensive amounts of time in an unchanging environment may be a contributing factor to poor cognitive function, and a potential area for intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Community Mental Health Center Visits and Community Mobility of People with Serious Mental Illnesses: A Facilitator or Constraint?

Mental health services and interventions have increasingly focused on the importance of community participation and mobility for people with serious mental illnesses (SMI). This study examined the role that visits to community mental health centers (CMHCs) may play in increasing community mobility of people with SMI. Eighty-nine adults with SMI receiving services at three CMHCS were tracked with GPS-enabled phones over a 13-day period. Findings revealed that participants visited more destinations on days they went to a CMHC compared to days they did not. They also spent more time out of the home and traveled greater distances. Results suggest that the benefits of visiting a mental health center appear to go beyond treatment outcomes, but also point to the possibility that obligations, whether to a clinic appointment or possibly vocational, educational, leisure, faith, or social commitments, may be an important stepping stone to more mobility and intentional, sustained community participation.

"Getting out of the house: The relationship of venturing into the community and neurocognition among adults with serious mental illness": Correction.

Reports an error in "Getting out of the house: The relationship of venturing into the community and neurocognition among adults with serious mental illness" by Bryan P. McCormick, Eugene Brusilovskiy, Gretchen Snethen, Louis Klein, Greg Townley and Mark S. Salzer (Psychiatric Rehabilitation Journal, Advanced Online Publication, Apr 01, 2021, np). In the original article, the following acknowledgments were missing from the author note: : "The contents of this article were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; Grant 901F0065-02-00; Mark S. Salzer, principal investigator). However, the contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and endorsement by the federal government should not be assumed. The authors are grateful to Kevin Frech, Stephany Wilson, Alison Weigl, Jared Pryor, David Glogoza and Katie Pizziketti for their assistance with data collection and analysis and to Alex Fechner for providing his implementation of the ST-DBSCAN algorithm in RapidMiner." All versions of the original article have been corrected. (The following abstract of the original article appeared in record 2021-32212-001). Objective: The purpose of this study was to determine if environmental novelty was associated with neurocognitive function among adults with serious mental illness. Method: Participants were recruited from community mental health centers (n = 117), and received a Global Positioning System (GPS) enabled cellular phone for 13 days. Data were also collected on cognitive function and recent participation in community-based activities. Independent samples t-tests were conducted to identify differences in neurocognitive function between participants who predominantly stayed in their homes ("homebodies") versus those who ventured more often from their homes ("venturers"). Analyses were also undertaken to identify if the nature of community participation activities mediated the relationship of neurocognitive function to group membership. Results: Overall, 74% of GPS signals were from participants' home residence. Homebodies demonstrated significantly poorer cognitive function than venturers, and this relationship was not mediated by a number of unique destinations or breadth of community participation activities. Conclusions and Implications for Practice: This study identified a subset of adults with serious mental illnesses who left their homes infrequently and who demonstrate significantly poorer cognitive function than those who left their homes more frequently. Spending extensive amounts of time in an unchanging environment may be a contributing factor to poor cognitive function, and a potential area for intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Relationship between Community Participation and Physical Activity among Individuals with Serious Mental Illnesses.

INTRODUCTION: The importance of physical activity (PA) and health outcomes for individuals with serious mental illnesses (SMI) has been well documented. It is also established that individuals with SMI engage in high amounts of sedentary behavior and low amounts of physical activity, which contributes to poor health outcomes. This study explores the relationship between community participation, physical activity, and sedentary behavior among individuals with SMI. METHODS: This study used a sample of individuals with SMI who were receiving community mental health services in a large urban area of the United States. Of the 526 individuals approached, 308 were interested in the study; 173 consented and completed data collection. This study reports on 152 participants who had complete data. Using the Temple University Community Participation Scale, participants reported on community-based activities completed independently in the previous 30 days. Additionally, participants were asked to wear a tri-axial accelerometer (ActiGraph GT3X) on the non-dominant wrist for seven days. The total number of community participation days was correlated with PA variables including steps, sedentary, light, and moderate-vigorous PA. Two groups of step data were analyzed using t-tests: ≥7500 steps, and ≥ 10,000 steps. Logistic regressions were run to examine the relationship between amount, breadth and sufficiency of community participation and having +/- 7,500 steps and +/- 10,000 daily steps, controlling for age, gender, and income. RESULTS: Amount of community participation was inversely associated with the % of time in sedentary activity and positively associated with the % of time in moderate to vigorous PA. Those with at or more than 7500 steps and 10,000 steps reported significantly more days of community participation. CONCLUSION: This study highlights the contribution of everyday activities for increased physical activity and reduced time spent in sedentary activity. Practitioners should consider recommendations for engagement in the community to increase opportunities for walking.

Depressive symptoms and community participation among individuals with serious mental illnesses.

Community participation is important to the well-being of people with serious mental illnesses. While theories suggest that depressive symptoms can negatively impact community participation, evidence from previous studies was inconclusive. This study analyzed the relationship between severity of depressive symptoms and various participation constructs including number of days of participation in various community activities, breadth of interests in participating in community activities, and satisfaction with the amount to which one participates. A national sample of individuals with serious mental illnesses (n = 296) was employed. Overall, those who were severely depressed had fewer total days of participation, reported fewer participation areas as important, were less likely to participate in those areas that were important to them, and were less likely to participate as much as they wanted to in areas that were important to them. This relationship generally remained even after controlling for demographics. Overall, the findings from this study suggest that greater attention should be paid to the relationship between depressive symptoms and community participation in this population, including explorations that examine how the promotion of participation may have an impact on depressive symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Welcoming places: Perspectives of individuals with mental illnesses.

There are many factors that influence community participation of individuals with serious mental illnesses. Research often focuses on barriers to participation. This study, however, takes a different approach, by exploring features of community locations considered welcoming by individuals with serious mental illnesses. This is important because welcoming environments are more likely to promote community participation. Using a survey approach, 75 participants were asked to identify and describe locations where they felt welcomed as a person with a mental illness. Our findings suggest that there are a number of places within the general community individuals with serious mental illnesses perceive as welcoming. Participants described religious communities, restaurants/cafés shops, parks, libraries, and cultural centers. Welcoming places were often perceived as architecturally open, featuring natural light and plants. Places provided opportunities for individuals to engage in a number of activities (e.g., socializing, entertainment, improving health, among others); data suggest welcoming places facilitated reciprocal relationships. We link these findings to a number of key recovery principles and make recommendation for multilevel interventions. This study may facilitate conversations with mainstream community organizations about inclusion and strategies to create welcoming environments and with mental health providers to consider strategies to encourage participation in welcoming places. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Emotional states associated with being in the community and being with others among individuals with serious mental illnesses.

Individuals with serious mental illnesses generally spend extensive amounts of time at home and alone. The aim of the current study was to examine differences in emotional states between being at home and being in the community, and between being alone and being with others. Ecological momentary assessment was utilized 3 times per day over 14 days with 91 individuals with serious mental illnesses to assess where they were, who they were with, and momentary feeling of depressed mood, loneliness, and happiness. A total of 2,257 data points were analyzed with hierarchical linear modeling. Participants were at home 70.6% of the time and alone 58.6% of the time. After controlling for diagnosis and symptoms, being in the community was associated with lower depressed mood, lower loneliness, and greater happiness, and being with others was associated with lower loneliness and greater happiness. There was no significant interaction effect between being at home and being alone on any emotional states. Being in the community and being with others contributed to more favorable emotional states among individuals with serious mental illnesses. These findings support the need to promote opportunities for community participation and interactions with others outside of one's home. Policies, programs, and clinical practices should align with the goal of supporting people with serious mental illnesses to actively engage in community living to facilitate their emotional well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining the relationship between community mobility and participation using GPS and self-report data.

Higher levels of community mobility have been shown to be associated with better physical health, mental health, and quality of life. The ability to move about one's community is also expected to facilitate community participation, which is an aspect of health functioning. This study uses Global Positioning Systems (GPS) technology to track various dimensions of community mobility, such as destinations, time outside the home, and distance traveled, and examine the relationship between these variables and community participation in a sample of individuals with serious mental illnesses (SMI). This population was selected because they are known to have diminished health functioning in terms of their community participation, and the goal is to explore the extent to which mobility limitations may account for this. A total of 103 individuals with serious mental illnesses were recruited from mental health agencies and consented to having their mobility tracked using GPS for 13 days and answering questions about their community-based activities. Greater amount of participation was associated with having more destinations and spending more time out of the house, but not with traveling larger distances and having a greater activity space. None of the mobility variables were related to the number of important participation areas or sufficiency of participation. The findings support the hypothesis that greater mobility is related to more participation, although satisfaction with the degree to which one participates does not appear to be impacted, suggesting that other factors need to be accounted for. Health policymakers and providers should pay attention to community mobility as a factor that affects health outcomes such as participation, in individuals with serious mental illnesses, and other populations. In particular, attending to access to personal transport, public transportation, and other mobility options appears to be important, as well as interventions aimed at encouraging greater community mobility.

Loneliness and its association with physical health conditions and psychiatric hospitalizations in people with serious mental illness.

OBJECTIVE: Explore the association between loneliness and psychiatric hospitalizations, functioning, and physical health conditions in people with serious mental illness. METHODS: Data were included from 349 individuals with serious mental illnesses, aged 18+ years, who participated in two consecutive cross-sectional survey studies conducted between 2013 and 2018. RESULTS: A higher number of psychiatric hospitalizations in the past six months was associated with greater loneliness. The Short-Form-12 mental component score was a highly significant correlate, accounting for a significant amount of variance in loneliness scores. The physical component score and the bodily pain subdomain of the Short-Form-12 were also significantly associated with loneliness, with individuals with lower physical functioning and greater bodily pain reporting more loneliness. Having a higher total number of health conditions, higher total number of conditions that cause pain, and the presence of at least one respiratory condition were found to be associated with greater loneliness. DISCUSSION: Loneliness may be an important dimension of health as related to health conditions associated with pain, functioning, and psychiatric hospitalizations among people with serious mental illness. These finding reinforce the powerful role of socio-cultural and environmental factors in shaping whole health in people with serious mental illness.

Community participation factors and poor neurocognitive functioning among persons with schizophrenia.

Poor neurocognitive functioning among individuals with schizophrenia is typically conceptualized as resulting from a disease process. The objective of this article is to further expand understanding of poor neurocognition beyond pathogenesis toward a perspective that also incorporates community participation factors. This article focuses on three such factors-sedentary behavior, loneliness, and poverty-that have been demonstrated to be related to neurocognition and are highly prevalent among individuals with schizophrenia. This article provides an overview of the research on each factor and discusses its possible connection to neurocognitive challenges for individuals with schizophrenia. Implications for research, policy, and practice efforts are then proposed to broaden approaches to understanding and addressing neurocognitive challenges in this population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

An Examination of the Community Participation Interests of Young Adults with Serious Mental Illnesses.

Participation in various aspects of community life (e.g., education, employment) plays a critical role in fostering young adult development and health. To support behavioral health services in addressing a broader array of meaningful community participation areas, the current study examined the participation interests of young adults with serious mental illnesses via a literature review and focus groups interviews. Literature review results revealed a range of community participation areas of interest to these individuals, including employment, education, religion and spirituality, social networking (e.g., using social media), volunteering activities, socializing, and civic and artistic participation (e.g., attending a political event, playing music). Focus group participants named many of these same areas, but also mentioned unique areas of participation that have not been the focus of previous research (i.e., playing games, sports, exploration of other communities (e.g., traveling), hanging out, and nature-based participation). Implications for future research and behavioral health practice are discussed.

Correction: Mobile health-based physical activity intervention for individuals with spinal cord injury in the community: A pilot study.

[This corrects the article DOI: 10.1371/journal.pone.0223762.].

Mobile health-based physical activity intervention for individuals with spinal cord injury in the community: A pilot study.

Low levels of physical activity (PA) and high levels of sedentary behavior in individuals with spinal cord injury (SCI) have been associated with secondary conditions such as pain, fatigue, weight gain, and deconditioning. One strategy for promoting regular PA is to provide people with an accurate estimate of everyday PA level. The objective of this research was to use a mobile health-based PA measurement system to track PA levels of individuals with SCI in the community and provide them with a behavior-sensitive, just-in-time-adaptive intervention (JITAI) to improve their PA levels. The first, second, and third phases of the study, each with a duration of one month, involved collecting baseline PA levels, providing near-real-time feedback on PA level (PA Feedback), and providing PA Feedback with JITAI, respectively. PA levels in terms of energy expenditure in kilocalories, and minutes of light- and moderate- or vigorous-intensity PA were assessed by an activity monitor during the study. Twenty participants with SCI took part in this research study with a mean (SD) age of 39.4 (12.8) years and 12.4 (12.5) years since injury. Sixteen participants completed the study. Sixteen were male, 16 had paraplegia, and 12 had complete injury. Within-participant comparisons indicated that only two participants had higher energy expenditure (>10%) or lower energy expenditure (<-10%) during PA Feedback with JITAI compared to the baseline. However, eleven participants (69.0%) had higher light- and/or moderate-intensity PA during PA Feedback with JITAI compared to the baseline. To our knowledge, this is the first study to test a PA JITAI for individuals with SCI that responds automatically to monitored PA levels. The results of this pilot study suggest that a sensor-enabled mobile JITAI has potential to improve PA levels of individuals with SCI. Future research should investigate the efficacy of JITAI through a clinical trial.

Associations Between Physical Health Limitations and Community Participation Among People With and Without Serious Mental Illnesses.

OBJECTIVE: Research has suggested that individuals with serious mental illnesses are not as physically healthy as the general population and are more likely to experience physical illnesses such as diabetes, obesity, and cardiovascular and respiratory diseases. Less is known about how physical health may be related to community participation among individuals with serious mental illnesses, although research with adults in the general population has suggested strong negative associations between health impairments and engagement in a variety of activity domains. METHODS: In this study, the authors drew from two national data sets to examine the relationship between physical health impairments and community participation among 300 participants with serious mental illnesses and 300 participants without serious mental illnesses. RESULTS: For participants in both groups, physical health concerns and use of mobility aids were associated with lower reported rates of community participation. CONCLUSIONS: Findings shed light on the complex association between physical health impairments and community participation while also suggesting the need to focus on other potential barriers to participation among individuals with serious mental illnesses.

An exploration of linear and curvilinear relationships between community participation and neurocognition among those with serious mental illnesses.

OBJECTIVE: Longitudinal research supports an effect of participation in aspects of community life (e.g., leisure activity, employment) on neurocognition in the general population. This study examined the extent and nature of the relationship between community participation and neurocognition among people with serious mental illnesses. METHOD: Participants included 168 adults with schizophrenia spectrum or affective disorder diagnoses who completed the Temple University Community Participation Measure and Brief Assessment of Cognition in Schizophrenia. Hierarchical multiple regression analyses explored linear and curvilinear effects of the amount and breadth of community participation on neurocognition. RESULTS: Significant linear relationships existed between amount of community participation and overall neurocognitive functioning, motor speed, verbal fluency, and attention/processing speed, and between breadth of participation and verbal fluency. Significant curvilinear effects were noted between amount of community participation and verbal memory, and between breadth of community participation and overall neurocognitive functioning and motor speed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings suggest that enhanced community participation may contribute to improved neurocognitive functioning, further supporting the importance of this rehabilitation target. (PsycINFO Database Record (c) 2019 APA, all rights reserved).