[Lifestyle in young adults with and without a psychotic disorder]. / Leefstijl bij jongvolwassenen met en zonder psychotische stoornis.

Background Patients with psychotic disorders have a higher risk of physical illnesses on account of genetic predisposition, poorer access to healthcare, medication use, environmental factors and lifestyle. Because healthy lifestyle behaviour is established at young age, it is important to signal problems in good time. A lifestyle screening might be useful in this respect. Aim To describe the lifestyle characteristics of patients in a mental health clinic for young adults (age: 18-28 years) with early psychotic disorder based on parts of the instrument ‘Lifestyle-in-the-picture’ compared to healthy controls. We also discuss experiences of lifestyle coaches in applying ‘Lifestyle-in-the-picture’. Method Lifestyle characteristics and lifestyle behaviour of 90 patients with a psychotic disorder and 137 young adults from the general population were compared quantitatively. Additionally, interviews were held with lifestyle coaches as to the use of the instrument ‘Lifestyle-in-the-picture’. Results The young adult patients had considerably poorer results on lifestyle aspects than controls: increased body mass index (BMI 53% versus 18%), smoking, addiction and unhealthy eating and activity patterns. They were more dissatisfied with their physical and mental health. According to the lifestyle coaches, the ‘Lifestyle-in-the-picture’ instrument was a good starting point to work on improvement with patients since the instrument provided insight in the healthy and unhealthy aspects of their lifestyle and gave directions to set goals. Conclusions Young adults with a psychotic disorder have an unhealthy lifestyle and also more risk factors compared to controls. Lifestyle screening programmes are important to discuss health risks in time and which steps for improvement can be taken. The step from insight to actual more healthy behaviour is challenging.

'I am proud of how I handled it'. Exploring the impact of the COVID-19 pandemic and related restrictions on well-being of adults with severe mental illness using qualitative methods.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and related restrictions globally impacted mental health, particularly for those with pre-existing severe mental illness (SMI). This qualitative study examined how adults with SMI perceived the effects of the COVID-19 pandemic and related restrictions in the Netherlands, focusing on their personal recovery, well-being and daily life, including an exploration of factors influencing these effects. METHODS: Semi-structured interviews were conducted, audio-recorded and transcribed verbatim. Reflexive thematic analysis was applied. Purposive sampling was used to ensure diversity of individuals with SMI (i.e., age, gender, diagnosis, cultural background and mental healthcare institution). RESULTS: Twenty participants (median age: 45 years [SD: 12, 8]; 11 females) were interviewed between May and July 2023. Findings revealed a wide range of experiences: while some individuals reported a negative impact on their existing psychiatric symptoms, others described adaptability, resilience and even positive effects of COVID-19 restrictions on their mental health and well-being. Factors influencing the heterogeneic perceptions of the COVID-19 pandemic and related restrictions include the availability of trusted social relationships and enduring interactions with health professionals. CONCLUSION: Personalised support, both socially and professionally, is crucial for addressing fears, building resilience, reducing isolation and encouraging positive coping strategies for individuals with SMI during external crises. In this project, a participatory research approach that integrated the lived experience perspective helped uncover the unique perceptions of people with SMI with regard to the pandemic and related restrictions. PATIENT OR PUBLIC CONTRIBUTION: The study used a participatory action research approach, with experts-by-experience involved in every stage of the project as part of the research team. This included engagement with the funding application process, recruitment strategies for interviews, developing the interview guide, piloting the interview, interpreting findings, and knowledge dissemination activities.

[Migration background and care needs of patients with severe mental illness: an empirical exploration]. / Migratieachtergrond en zorgbehoeften bij patiënten met een ernstige psychiatrische aandoening.

BACKGROUND: A substantial number of mental health care patients have a migration background. It is not clear whether they are given the right sort of care. AIM: To investigate the differences in care needs between patients from western countries and non-western first- and second-generation migrants with severe mental illness (SMI). METHOD: In a cross-sectional study the Camberwell Assessment of Needs was filled in by 914 patients and also by their mental health professionals. We looked at differences in needs in general and specifically at care needs that were met and that were not met for patients of western origin and first-and second generation non-western migrants. These differences were analysed based on care areas: ‘activities of daily living’, ‘mental health’, ‘rehabilitation’ and ‘services’. RESULTS: According to both patients and mental health workers, there were more needs for care with patients in the first and (to a lesser degree) the second generation of non-western migrants. The number of unmet needs is particularly higher for the domains 'mental health' and 'services' experienced by patients with a first generation migration background. Furthermore, for the first generation, mental health care workers mentioned more unmet needs in the rehabilitation domain. Further professionals proved to be uninformed significantly more often about the needs of patients with a migration background, that specifically does concern the items intimate relationships and sexuality. CONCLUSION: Patients with SMI and a non-western migration history have more (unmet) needs for care than western patients with SMI. * BOTH FIRST AUTHORS.

[Regional healthcare labels: differences in care needs and psychosocial functioning]. / Regionale zorgvignetten: verschillen in zorgbehoeften en psychosociaal functioneren.

BACKGROUND: Severe mental illnesses (SMI) are associated with high mental healthcare and other healthcare costs. In 2012, mental healthcare labels were developed to create more transparency between insurance companies, municipalities, and mental healthcare. The labels are based on care intensity, and should provide a regional overview of the present groups of patients with SMI.
AIM: Explore the functionality and validity of the used labels in relation to needs for care and psychosocial functioning.
METHOD: The ROM data (needs for care, functioning) from 706 patients were tested per label by Chi-square tests and ANOVAs. For two high complex labels (alarming care avoiders and persons with safety risks), repeated measures ANOVAs and McNemar tests were used to analyse changes in functioning and needs over time.
RESULTS: To a limited extent, the labels were distinctive in care needs and functioning. The most restrictions in functioning and (unfulfilled) needs were present in the labels 'alarming care avoiders' and 'avoiding danger'. These findings were stable over time.
CONCLUSION: The labels are not sufficiently distinctive. To enhance regional care planning, it is desirable to combine existing information on healthcare labels with information on care needs and functioning. KEY WORDS functioning, mental healthcare labels, needs for care, routine outcome monitoring, severe mental illness.

Identifying social participation subgroups of individuals with severe mental illnesses: a latent class analysis.

PURPOSE: To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI). METHODS: A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups. RESULTS: Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender. CONCLUSIONS: Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning.