Social Support for Diet and Exercise Among Persons with Serious Mental Illness Enrolled in a Healthy Lifestyle Intervention

Background:  There is a lack of research on social support for changing health compromising behaviors such as physical inactivity and poor dietary habits among persons with serious mental illness (SMI) who face disproportionate morbidity and premature death due to cardiovascular disease.  Social support from family members and significant others has received increasing attention as a mediator or moderator of health outcomes, and has been the target of lifestyle modification interventions for persons with a variety of medical conditions in the general population.  However, the person’s natural support system has been a neglected resource for enhancing lifestyle interventions in the SMI population.  The purpose of this study was to examine social support for diet and exercise among participants with SMI newly enrolled in a healthy lifestyle intervention.  Methods: Merged baseline data from two ongoing studies of the In SHAPE health mentor intervention for persons with SMI were included in the analysis (N=158).  Participants had a SMI (schizophrenia, schizoaffective disorder, major depression, or bipolar disorder) and were enrolled in In SHAPE, an integrated health promotion program delivered in public mental health settings designed to improve physical fitness through dietary change and increasing exercise in adults with SMI.  Social support for health behavior change was calculated using the Social Support for Diet and Exercise Survey, a validated tool measuring both positive and negative experiences of social support.  Other baseline assessments included demographic characteristics, psychiatric symptoms, and health behaviors and status. Cross-sectional analyses examined social contact and correlates of social support.  Multiple linear regression was used to assess the relationship between demographic characteristics, psychiatric symptoms, health, and social support.  Results: The majority (80.3%) of participants reported face-to-face contact at least twice monthly with a family member or a close friend.  Bivariate correlations indicated that contact with family members, r(88) = .26, p < .05, and friends, r(95) = .28, p < .01, was positively and significantly associated with discouragement for healthy eating behaviors.  Multiple linear regression analysis revealed that participants’ readiness to change physical activity behaviors was significantly associated with criticism from family for exercise behaviors, r(64) = .29, p < .05.  Depressive symptoms (b=.35, p < .001) were associated with discouragement from family for healthy eating after controlling family contact, while readiness to change dietary portion size (b=.34, p < .01) was significantly associated with encouragement for healthy eating from friends.  Conclusions and Implications: Our findings suggest that the majority of persons with SMI newly enrolled in a healthy lifestyle intervention had regular contact with family members and trusted friends who were a source of both positive and negative social support for healthy eating and exercise.  As is the case for general population, interventions should teach skills and provide resources for coping with unhealthy social environments.  In addition, social work clinicians can help persons with SMI to manage mental health symptoms that may hinder their ability to seek and engage natural supports in the process of initiating and maintaining lifestyle change.