This study investigated the association between sedentary behavior (SB) and anxiety, and explored factors that influence this relationship in six low- and middle-income countries.
Cross-sectional ...data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. Multivariable linear and logistic regression analyses were conducted to assess the association between anxiety and self-reported SB. Potentially influential factors were examined with mediation analysis.
The sample consisted of 42,469 adults aged≥18years (50.1% female; mean age 43.8years). After adjusting for sociodemographics and country, people with anxiety engaged in 24 (95%CI=7–41) more minutes per day of SB than non-anxious individuals; the corresponding figure for the elderly (≥65years) was much higher (55min; 95% CI=29–81). Anxiety was associated with a 2.0 (95%CI=1.5–2.7) times higher odds for high SB (i.e., ≥8h/day). Overall, the largest proportion of the high SB-anxiety relationship was explained by mobility limitations (46.8%), followed by impairments in sleep/energy (44.9%), pain/discomfort (31.7%), disability (27.0%), cognition (13.3%), and physical activity levels (6.3%).
Anxiety was significantly associated with high SB, particularly among older adults. Future longitudinal studies are warranted to disentangle the potentially complex interplay of factors that may influence the anxiety-SB relationship.
•People with anxiety have a two-fold higher odds for being sedentary (+8 hours/day).•Mobility problems, pain and disability should be considered.•Cognitive problems influenced the relation between sedentary behavior and anxiety.
Despite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health ...co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs).
Cross-sectional, community-based data on 190 593 individuals from 43 LMICs recruited via the World Health Survey were analysed. Multivariable logistic regression analysis was done to assess the association between depression and physical multimorbidity.
Overall, two, three and four or more physical health conditions were present in 7.4, 2.4 and 0.9% of non-depressive individuals compared with 17.7, 9.1 and 4.9% among people with any depressive episode, respectively. Compared with those with no depression, subsyndromal depression, brief depressive episode and depressive episode were significantly associated with 2.62, 2.14 and 3.44 times higher odds for multimorbidity, respectively. A significant positive association between multimorbidity and any depression was observed across 42 of the 43 countries, with particularly high odds ratios (ORs) in China (OR 8.84), Laos (OR 5.08), Ethiopia (OR 4.99), the Philippines (OR 4.81) and Malaysia (OR 4.58). The pooled OR for multimorbidity and depression estimated by meta-analysis across 43 countries was 3.26 (95% confident interval 2.98-3.57).
Our large multinational study demonstrates that physical health multimorbidity is increased across the depression spectrum. Public health interventions are required to address this global health problem.
Objective
To provide meta‐analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs).
Method
Three independent authors ...searched major electronic databases from inception till August 2015 for cross‐sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures.
Results
Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = −1.51, 95% CI = −1.75, −1.27, studies = 42), total hip (SMD = −1.56, 95%CI = −1.84, −1.28, studies = 23), intertrochanteric region (SMD = −1.80, 95%CI = −2.46, −1.14, studies = 7), trochanteric region (SMD = −1.05, 95%CI = −1.44, −0.66, studies = 7), and femoral neck (SMD = −0.98, 95%CI = −1.12, −0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30–47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17–2.89, I2 = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC.
Conclusion
People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.
Objective
To conduct a meta‐analysis investigating the prevalence of pain in people with bipolar disorder (BD).
Method
A systematic review and random effects meta‐analysis searching major electronic ...databases from inception till 01/2014 in accordance with the PRISMA statement. We included articles reporting quantitative data on the prevalence of pain in people with BD with or without a healthy control group. Two independent authors conducted searches, extracted data, and completed methodological quality assessment.
Results
Twenty two cross‐sectional studies were included, representing 12 375 644 individuals (BD n = 171 352, n controls = 12 204 292). The prevalence of pain in people with BD was 28.9% (95% CI = 16.4–43.4%, BD n = 171 352). The relative risk (RR) of pain in BD compared to controls was 2.14 (95% CI = 1.67–2.75%, n = 12 342 577). The prevalence of migraine was 14.2% (95% CI = 10.6–18.3%, BD n = 127 905), and the RR was 3.30 (95% CI = 2.27–4.80%, n = 6 732 220).About 23.7% (95% CI = 13.1–36.3%, n = 106 214) of people with BD experienced chronic pain. Age, percentage of males, methodological quality, and method of BD classification did not explain the observed heterogeneity.
Conclusion
People with BD experience significantly increased levels of pain (particularly chronic pain and migraine). The assessment and treatment of pain should form an integral part of the management of BD.
Metabolic and cardiovascular health problems have become a major focus for clinical care and research in schizophrenia.
To evaluate the content and quality of screening guidelines for cardiovascular ...risk in schizophrenia.
Systematic review and quality assessment of guidelines/recommendations for cardiovascular risk in people with schizophrenia published between 2000 and 2010, using the Appraisal of Guidelines for Research and Evaluation (AGREE).
The AGREE domain scores varied between the 18 identified guidelines. Most guidelines scored best on the domains 'scope and purpose' and 'clarity of presentation'. The domain 'rigour of development' was problematic in most guidelines, and the domains 'stakeholder involvement' and 'editorial independence' scored the lowest. The following measurements were recommended (in order of frequency): fasting glucose, body mass index, fasting triglycerides, fasting cholesterol, waist, high-density lipoprotein/low-density lipoprotein, blood pressure and symptoms of diabetes. In terms of interventions, most guidelines recommended advice on physical activity, diet, psychoeducation of the patient, treatment of lipid abnormalities, treatment of diabetes, referral for advice and treatment, psychoeducation of the family and smoking cessation advice. Compared across all domains and content, four European guidelines could be recommended.
Four of the evaluated guidelines are of good quality and should guide clinicians' screening and monitoring practices. Future guideline development could be improved by increasing its rigour and assuring user and patient involvement.
Vancampfort D, Probst M, Sweers K, Maurissen K, Knapen J, De Hert M. Relationships between obesity, functional exercise capacity, physical activity participation and physical self‐perception in ...people with schizophrenia.
Objective: This study compared differences in functional exercise capacity between patients with schizophrenia and healthy controls. Physical self‐perception and physical activity variables contributing to the variability in the distance achieved during a walk test were identified.
Method: A total of 25 normal weight, 25 overweight and 10 obese patients and 40 healthy volunteers were included. Functional exercise capacity was explored with a 6‐minute walk test. Level of physical activity was assessed using the Baecke questionnaire and physical self‐perception using the physical self‐perception profile.
Results: Obese patients walked a significantly shorter distance than overweight and normal weight patients (450.6 ± 97.7, 580.2 ± 116.0 and 615.8 ± 92.4 m resp., P < 0.001). All patients walked a shorter distance than healthy controls (710.6 ± 108.4 m, P < 0.001). Dyspnoea was only prevalent in schizophrenia (28.3%, P < 0.001) and especially in obese patients (90% vs. 40% in overweight and 27.3% in normal weight patients, P < 0.001). In multiple regression analysis, 59% of the variance in walking distance was explained by body mass index, perceived sports competence and condition, physical self‐worth, level of sports participation and smoking behaviour.
Conclusion: Functional exercise capacity in patients with schizophrenia is reduced not only by obesity, perceived discomfort and pain but also by a sedentary, unhealthy life style and a reduced physical self‐perception.
Objective
High rates of smoking and nicotine dependence are associated with increased physical comorbidity and premature death in people with schizophrenia. We conducted a clinical overview to ...establish how smoking cessation should be promoted in practice.
Method
Systematic clinical review of major electronic databases from inception till November 2014.
Results
A growing body of evidence supports pharmacological interventions to assist smoking cessation. The most promising evidence is for bupropion with several meta‐analyses demonstrating its effectiveness. Currently, there is limited evidence demonstrating the effectiveness of nicotine replacement therapy (NRT) and varenicline, although this is likely to be due to the paucity of research. There are no consistent data to suggest that pharmacological interventions increase adverse events. Behavioural and psychosocial interventions also demonstrate promise, particularly when combined with pharmacotherapy. Careful monitoring of antipsychotic levels (in particular clozapine) is essential, and the promotion of physical activity may be useful to negate potential weight gain and diabetes risk following smoking cessation.
Conclusion
Evidence from systematic reviews and meta‐analyses suggests that smoking cessation interventions are effective in people with schizophrenia, although more long‐term research is required. Promoting smoking cessation should be given utmost priority in clinical practice, and we offer practical strategies to facilitate this.
Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are ...associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness.
The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Patients with a DSM or ICD mental illness diagnoses were recruited and completed the SIMPAQ on two occasions, one week apart. Participants wore an Actigraph accelerometer and completed brief cognitive and clinical assessments.
Evidence of SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Data were obtained from 1010 participants. The SIMPAQ had good test-retest reliability. Correlations for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Evidence of validity for the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had stronger evidence of validity. This alternative method is recommended for use in future studies employing the SIMPAQ.
The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals.
Background
Clinical staging models describe where an individual exists on a continuum from asymptomatic at‐risk states (Stage 0) through to established late‐stage disease (Stage 4). We applied this ...framework to systematically assess evidence for any associations between objectively assessed cardiorespiratory fitness (CRF) and stage of psychosis.
Method
Nine electronic databases were searched for relevant publications from inception until October 31, 2019. Pooled effect sizes (Hedges’ g and 95% confidence intervals (95% CI)) were estimated for differences in CRF for studies that reported mean oxygen uptake (max, peak, or predicted VO2 in ml/kg/min).
Results
Thirty‐eight studies were eligible. Findings indicated that suboptimal CRF can be present at Stages 0 and 1. Meta‐analyses of 22 studies demonstrated that CRF was significantly reduced in individuals classified between Stages 1 and 4 compared with matched or general population controls (g = −0.93; 95% CI −1.14, −0.71). Mean VO2 was decreased by 28% in Stage 4 compared with Stage 1 (34.1 vs. 24.66 ml/kg/min); the largest effect size for CRF reduction was reported between Stages 2 and 3 (g = −1.16; 95% CI −1.31, −1.03).
Conclusions
Although not identifying direct causal links between clinical stage and CRF, using this framework may enhance understanding of co‐associations between mental and physical health markers across the entire spectrum of psychosis. Limitations include lack of research on CRF in Stages 0 and 1 alongside problems determining stage in some studies. However, impaired CRF is reported in emerging psychosis, supporting calls that early intervention programmes should address both mental and physical wellbeing.
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