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Influence of a life style intervention among persons with a psychiatric disability: a cluster randomised controlled trail on symptoms, quality of life and sense of coherence
Umeå University, Faculty of Medicine, Omvårdnad.
Umeå University, Faculty of Medicine, Omvårdnad.
Umeå University, Faculty of Medicine, Clinical Sciences, Psychiatry.
(English)In: Journal of Clinical Nursing, ISSN 0962-1067Article in journal (Refereed) Accepted
Abstract [en]

Aims and objectives: The aim of this study was to investigate how a life style intervention programme influences psychiatric and psychosocial factors among persons with psychiatric disabilities.

 Background: Persons with psychiatric disabilities often suffer from a simultaneous physical health problem, where circulatory disorder, hyperlipideamia, digestive disease, diabetes mellitus and obesity are prevalent. Studies have also shown a relationship between physical activity and mental health. But few randomised controlled trails have been aimed specifically at life style interventions and their effect on psychiatric health and quality of life among persons with psychiatric disabilities.

Design: a cluster randomised controlled trail.

Methods: Forty one persons with a DSM- ІV diagnosis in eight supported housing facilities and two housing support programmes and their carers were on cluster level randomly assigned to a 12 month health intervention programme in the form of study circles with diet sessions and physical activities or a control programme. The changes in the mean of quality of life, level of functioning, psychiatric symptoms and sense of coherence was investigated and its relationship to physical health and attendance.

Results: A significant increase in the sense of coherence was seen in both programmes but also significant improvements in the intervention group compared to controls at the follow-up.

Conclusions: Structured activities in the form of life style intervention programmes with a sufficient level of challenge that encourage persons with psychiatric disabilities to participate in activities in a social context may contribute to a significant increase in the sense of coherence.

Relevance to clinical practice: Improving physical health with life style programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

Keyword [en]
Psychiatric disability, physical health, health intervention, Sense of Coherence, psychosocial factors, RCT.
National Category
Research subject
Caring Sciences
URN: urn:nbn:se:umu:diva-25941OAI: diva2:235192
Available from: 2009-09-14 Created: 2009-09-14 Last updated: 2009-09-21Bibliographically approved
In thesis
1. Att främja förändrad livsstil bland personer med psykiskt funktionshinder: studier av metabola och psykologiska effekter, upplevd mening och hälsa
Open this publication in new window or tab >>Att främja förändrad livsstil bland personer med psykiskt funktionshinder: studier av metabola och psykologiska effekter, upplevd mening och hälsa
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
To promote life style changes among persons with psychiatric disabilities : studies of metabolic and psychological effects, experienced meaning and health
Abstract [en]

The overall aim of this thesis is to investigate if the somatic comorbidity and increased mortality among persons with psychiatric disability (residents in supported housing facilities) can be influenced. The thesis comprises four papers. Paper I describes the lived experience of health and body. Papers II and III examine the effects of a lifestyle programme on physiological markers (II) and on psychological and quality of life parameters (III). Paper (IV) illustrates the meaning of participating in a life style programme. The data in Papers I and IV comprises narrative interviews with residents (n=11). The studies in Papers II and III are focused on residents and were carried out with a randomized design. The randomization was performed on a group level (supported housing facility). The 12 month intervention consisted of study circles with a theoretical and practical application of dietary information and physical activity for two hours, on a twice weekly basis under the supervision of a study circle leader. The controls were offered an aesthetic study circle and met once a week. The data in Paper II comprises physiological quantitative data from both residents (n=41) and staff (n=41) and in Paper III questionnaires on symptoms and quality of life completed only by residents (n=41). The data was analysed with Qualitative description (I), Phenomenological-hermeneutics (IV), and for papers II and III relevant statistical calculations were used. Health is described in paper I as “having a life as others have” and discloses the losses of important life domains (family, work, security) and the experiences of being deviant and stigmatized. Health is described as “absence of psychological and physical problems” and its hampering effects on quality of life and self-esteem. Health is understood as a phenomenon that could “be influenced by one self”, and there is an insight that health is manageable. Participating in a life style intervention (paper II) meant a significant improvement in risk factors for metabolic syndrome among the residents in comparison with controls. No differences were seen on weight, BMI and improved physical capacity. In paper III a significant positive increase in the Sense of Coherence compared to controls was seen. However no effect was seen on quality of life, psychosocial function or on reduction of symptoms in comparison with controls. Participating in a lifestyle intervention can be understood as the gaining of insights that health can be improved and that the daily life is partly given a changed content (paper II). The participation is also described as meaning an increased sense of closeness and equality in relation to the staff and sometimes a painful insight of their life situation. Participating is also described as entailing a hope that one’s life situation can be affected. In summary this thesis shows that there is some possibility of influencing the physical health (reduced risk of metabolic syndrome) among persons with psychiatric disability by participating in a 12 month intervention programme. The intervention does not show any effects on measures such as quality of life, psychosocial function and presence of symptoms. However, the participants describe that the participation had a meaning in a number of respects. This is a finding that is confirmed by the positive change in sense of coherence. The need to develop preventive care for persons with psychiatric disability and the importance of monitoring the treatment with neuroleptics and its side effects on physical health is an important clinical implication. Furthermore the importance of the responsibility of the care staff is emphasized as well as the importance of supporting a change in lifestyle.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2009. 91 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1277
community psychiatric nursing, life style intervention, lived experience, health, metabolic syndrome, psychiatric illness, randomized controlled trail, sense of coherence, Personer med psykiskt funktionshinder, omvårdnad, socialpsykiatri, hälsa, metabolt syndrom, livsstil, RCT, KASAM, livsvärld
National Category
Research subject
Caring Sciences
urn:nbn:se:umu:diva-25947 (URN)978-91-7264-822-7 (ISBN)
Institutionen för omvårdnad, 90187, Umeå
Public defence
2009-10-09, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (Swedish)
Available from: 2009-09-21 Created: 2009-09-14 Last updated: 2011-10-06Bibliographically approved

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