Predictors of Health Behaviors Among People with Severe Mental Illness Residing in the Community

Background and purpose:  Physical health is an issue of great concern for people living with serious mental illnesses (SMI); yet focus of treatment for this vulnerable and marginalized population has been mainly psychiatric, often ignoring their physical health lifestyle. People with SMI suffer from poor physical health, have higher rates of physical disorders and higher mortality rates. Moreover, their life expectancy is significantly shorter than that of the general population, largely due to chronic medical conditions which are mostly preventable and treatable. Although causes of chronic medical conditions in developed countries are multifactorial, unhealthy lifestyles, i.e. poor health behaviors – such as poor diet and sedentary lifestyle- are major yet modifiable risk factors of chronic physical diseases. Among people with SMI, the rates of poor health behaviors are higher compared to the overall population, contributing to increased risk of chronic physical diseases. This study examined explanatory factors of two health behaviors (namely healthy diet and physical activity) among people with SMI who reside in the community in Israel.

Methods: Participants (n= 145) were aged 18 and above, diagnosed with a severe mental illness according to the Israeli National Insurance Institute, resided in the community, and participated in a mental health rehabilitation program. Participants were recruited from community mental health rehabilitation workshops in Israel and filled out a survey assessing levels of engagement in physical activity, keeping a healthy diet, self-efficacy, motivation, social support, and knowledge regarding health behaviors.

Results: Over half of participants (60%) resided in sheltered housing programs, and the rest resided with their families. Those residing in halfway houses kept on average a healthier diet than those residing with their families, but no significant difference was found between type of residence and physical activity. Regression analyses showed that higher motivation predicted both health behaviors- physical activity and healthy diet (B=.19, p<.05, B =.29, p<.01, respectively). In addition, greater knowledge and self-efficacy predicted physical activity health behavior (B= .20, p<.01; B= .48, p<.0001, respectively) and self-efficacy mediated the association between social support and physical activity health behavior [ind_F=0.08, 95%; CI=(0.06, 0.16)].

Conclusions and implications: Motivation seems to be a key factor in promoting physical activity and healthy diet among people with SMI, whereas self-efficacy, knowledge and social support seem to promote only physical activity. Interventions to promote health behaviors among people with SMI should be implemented in community services and tailored to people residing in various housing arrangements and to the various health behaviors necessary to promote. Interventions should focus on promoting motivation, self-efficacy and knowledge. Future research should further the understanding of the unique predictors of different health behaviors, such as examine the role of knowledge and social support in keeping a healthy diet, in order to build optimal interventions for promoting health behaviors.