Association between Health Risk Behaviors on General Health Conditions in Individuals with Serious Mental Illness

Abstract

Background: Approximately 9.8 Americans adults in the U.S. suffer from severe mental illness (SMI) each year. People living with SMI have a shorter lifespan and greater co-morbid health problems than the general population. Literature has indicated that health risk behaviors, such as physical inactivity, poor diet, smoking, and excessive alcohol intake, are commonly found in individuals with SMI. These behaviors play important roles in the development of co-morbid health problems that are causes of early death. Since previous studies have mainly focused on the association between the combination of four health risk behaviors and general health condition in the general population, this study aims to examine the association between health risk behaviors and physical health condition of individuals with SMI.

Methods: A secondary data analysis of the California Health Interview Survey (CHIS) 2013-2014 wave was utilized. The CHIS, the largest population-based state health survey, has been conducted since 2001 across the two-year cycle by using a random-digit telephone method. Among 2013-2014 CHIS sample, a total of 1,299 adults with SMI comprised the sample for the present study. Kessler Psychological Distress Scale (K6) was used to determine the presence of SMI. The outcome variable was measured by using a single item asking respondents to rate their health: “would you say that in general your health is excellent, very good, good, fair, or poor?” The independent variables, four health risk behaviors, were classified as current smoking, unhealthy dietary behaviors including consumption of soda, sweetened beverage or fast food, alcohol use in past 12 months, and physical inactivity in past month. Age, gender, race, marital status, educational attainment, health care access, poverty status, insurance status, employment, the number of chronic disease, and obesity were identified as covariates. Due to the complex survey design of CHIS, survey data analysis procedures were used.

Results: Multivariate regression analyses revealed that physical inactivity was significant predictors of general health condition, indicating individuals who did not walk at least ten minutes for transportation in past week were less likely to rate their health condition as higher levels rather than poor, as compared to their counterparts (OR=0.63, p<0.05). Among controlling variables, older age, being in poverty and the number of chronic illness, including high blood pressure, asthma, diabetes, and heart disease, were negatively associated with general health condition among individuals with SMI (OR=0.71, 0.63, 0.46, respectively, p<0.05). Having a healthcare access rather than ER was also a marginally significant predictor of physical health status (p<0.1). However, alcohol consumption, smoking, and poor food intake had no effects on self-rated physical health status in individuals with SMI.

Conclusion and Implications: The study found that physically inactive individuals with SMI perceived their health to be poor. Individuals with SMI are more likely to be physically inactive and sedentary; their increased burden of health-related problems is associated with physically inactive lifestyles. Given that, providing effective physical activity interventions should be provided in the care of people with SMI.