Mitigating the Negative Health Effects of Antidepressants and Antipsychotics: the Relationship of Physical Activity and Distress to Health Outcomes Among Persons Taking Psychotropic Medicines

Background/purpose: The lifespan of people with severe mental illness (SMI) is shorter compared to the general population, resulting, in part, from physical illnesses (Hert et. al., 2011). Psychotropic medications can help improve the lives of persons with SMI; however, psychotropic medications have health related iatrogenic effects, which increase mortality. This is especially true for antipsychotic and antidepressant medicines. A further contributor to decreased life expectancy of persons with SMI is chronic stress. Chronic stress has been associated with increased reports of illness. Although stress is a normal part of life, chronic stress can lead to physical health problems, including high blood pressure, difficulty sleeping, headaches, stomach problems and chest pains. These symptoms in turn can lead to chronic, life threatening diseases, such as heart disease, high blood pressure, and diabetes.  Research suggests that increased physical activity is associated with reduced likelihood of diabetes, high blood pressure, and heart disease. Among the general population, research suggests that stress mediates the relationship between physical activity and disease. The purpose of the current research study is to test the mediating role of stress between physical activity and the presence of diabetes, high blood pressure, and heart disease among persons who take antidepressant and antipsychotic medications.

Methods:  Data for this research came from participants in the Canadian Community Health Survey (CCHS), Cycle 1.2. The investigators used a subset of participants who were taking psychotropic medications (n=2,420).  The researchers used Hayes’s (2012) method for testing mediating relationships and tested the hypothesis using logistic regression. Controlling for height, weight, gender, and diagnosis, the researchers estimated bootstrapped estimates of the direct and indirect effects – through stress --  of daily activity (energy expenditure) on the presence of disease (diabetes, high blood pressure, or hear disease).

Results:  The logistic regression model testing the mediation hypothesis was significant. The indirect effect, or mediation effect, partially explained the relationship between physical activity and the presence of diabetes, high blood pressure, and heart disease. Further, psychical activity was significantly and negatively related to the odds of having one of the three physical problems, and distress was significantly related to the likelihood of having one of the three physical health problems.

Conclusions/Implications:  The current findings support past research on the mediating role of stress between physical activity and health problems. Further research is needed to determine other mechanisms through which physical activity impacts health and identify additional coping strategies in order to moderate the impact of distress on health. Practically, the results suggest that persons who take psychotropic medicines should be encouraged to engage in exercise and develop additional positive coping strategies to combat distress. Given social work’s focus on the whole person, social workers are well situated to engage in integrated health and mental health care with clients, including encouraging physical activity and discovering and encouraging positive coping mechanisms.