Clinical trial of wellness training: health promotion for severely mentally ill adults.

This randomized controlled trial examined benefits of adding active health promotion to basic primary care (BPC) services for SMI adults. It compared BPC with BPC plus wellness training (WT), a 12 months intervention promoting individual skills in self-management. Three hundred nine participants enrolled during short-term residential treatment completed baseline assessments and were assigned to treatment groups, before discharge. Outcomes of perceived health status (SF-36), global assessment of function, and ratings of self-efficacy were assessed at follow-up interviews at 6, 12, and 18 months. The intent-to-treat analysis employed multilevel regression to examine differences by group on outcomes across time, controlling for health related covariates. The WT group showed significantly better outcomes on the SF-36 physical functioning and general health scales. Findings affirm ability of SMI adults to benefit from active health promotion.

History of arrest, incarceration and victimization in community-based severely mentally ill.

This study examined history of arrest and victimization in an urban community sample of severely mentally ill adults. Adults (n = 308) were consented and interviewed in one of four short-term residential treatment facilities in San Francisco. Nearly three quarters (71.4%) had been arrested at some time in their lives, 28.2% of whom had been arrested in the past 6 months. Substance use and homelessness were associated with history of arrest, while gender and ethnicity were not, although African Americans were more likely to have spent longer time in jail or prison. One quarter (25.6%) reported victimization. Being female (OR 2.02, 95% CI 1.2-3.5, p = 0.032) and homeless (OR 2.1, 95% CI 1.2-3.8, p = 0.013) were associated with reporting victimization. Severe mental illness, in particular in combination with substance abuse and homelessness, is associated with higher prevalence of both arrest and victimization history. Healthcare providers should solicit histories to include these events in order to understand and provide optimal care and case management services.

Predictors of physical functioning among adults with severe mental illness.

OBJECTIVES: Living conditions and treatment-related factors contribute to high rates of comorbid medical illness among adults with severe mental illness and undermine their physical well-being. This study examined physical functioning scores for this population and compared them with national norms. METHODS: A total of 309 residential care clients completed interviews. Diagnostic and sociodemographic variables were examined for significant associations with physical functioning, which was assessed with the Medical Outcomes Health Survey Short Form 36 (SF-36), and selected variables were entered into a hierarchical multiple regression analyses. Cross-sectional comparisons examined differences in scores between ten-year age groups in this sample and in the national data for men and women. RESULTS: In the final regression model, male gender, younger age, having earned income in the past six months, having less lifetime smoking, and having an admission diagnosis other than depression or schizophrenia spectrum disorders predicted better physical functioning. Functioning scores for the sample deviated from the national normed scores. Differences in functioning increased with each ten-year increment in age; study participants' functioning resembled that of cohorts ten to 20 years older. CONCLUSIONS: Determinants of physical functioning in this sample included well-known demographic predictors of health outcomes. The more striking finding was a deviation from normative data that began for study participants at the age of 25 years, indicating an early onset of limitations. The consistent trend of poorer functioning with each successive age group raises questions about the pace of physical decline among adults with mental illness that may be addressed in longitudinal studies.

The poor general health of the severely mentally ill: impact of schizophrenic diagnosis.

This study focused on poor health among the severely mentally ill and additional risks associated with schizophrenia. Records of 781 clients in short-term residential treatment programs provided data. The schizophrenic subgroup was compared to others in bivariate analyses, with significant findings included in logistic regression. Those with schizophrenia were more likely to be male, unemployed, and insured by MediCal/Medicare. Most health problems occurred at similar rates across diagnoses, reflecting common environmental risk factors. Those with schizophrenia had less substance abuse and fewer liver conditions, but more diabetes and chronic respiratory problems. Implications for providers and for research are discussed.