Long-term psychiatric inpatients' perspectives on weight gain, body satisfaction, diet and physical activity: a mixed methods study.

BACKGROUND: Obesity is a significant problem for people with serious mental illness. We aimed to consider body size from the perspective of long-stay psychiatric inpatients, focussing on: weight gain and its causes and impacts; diet and physical activity; and the perceived ability to make meaningful change in these domains. METHOD: A mixed methods study with 51 long-term psychiatric forensic and rehabilitation inpatients using semi-structured interviews combined with biometric and demographic data. RESULTS: 94% of participants were overweight or obese (mean BMI 35.3, SD 8.1). They were concerned about their weight, with 75% of them attempting to lose weight. Qualitative responses indicated low personal effectiveness and self-stigmatisation. Participants viewed their weight gain as something 'done to them' through medication, hospitalisation and leave restrictions. A prevailing theme was that institutional constraints made it difficult to live a healthy life (just the way the system is). Many had an external locus of control, viewing weight loss as desirable but unachievable, inhibited by environmental factors and requiring a quantum of motivation they found hard to muster. Despite this, participants were thoughtful and interested, had sound ideas for weight loss, and wished to be engaged in a shared endeavour to achieve better health outcomes. Consulting people as experts on their experiences, preferences, and goals may help develop new solutions, remove unidentified barriers, and improve motivation. CONCLUSIONS: The importance of an individualised, multifactorial approach in weight loss programmes for this group was clear. Patient-led ideas and co-design should be key principles in programme and environmental design.

Mood and the menstrual cycle.

BACKGROUND: Premenstrual mood symptoms are considered common in women, but such prevailing attitudes are shaped by social expectations about gender, emotionality and hormonal influences. There are few prospective, community studies of women reporting mood data from all phases of the menstrual cycle (MC). We aimed (i) to analyze daily mood data over 6 months for MC phase cyclicity and (ii) to compare MC phase influences on a woman's daily mood with that attributable to key alternate explanatory variables (physical health, perceived stress and social support). METHOD: A random sample of Canadian women aged 18-40 years collected mood and health data daily over 6 months, using telemetry, producing 395 complete MCs for analysis. RESULTS: Only half the individual mood items showed any MC phase association; these links were either with the menses phase alone or the menses plus the premenstrual phase. With one exception, the association was not solely premenstrual. The menses-follicular-luteal MC division gave similar results. Less than 0.5% of the women's individual periodogram records for each mood item showed MC entrainment. Physical health, perceived stress and social support were much stronger predictors of mood (p < 0.0001 in each case) than MC phase. CONCLUSIONS: The results of this study do not support the widespread idea of specific premenstrual dysphoria in women. Daily physical health status, perceived stress and social support explain daily mood better than MC phase.

The role of ovarian steroid hormones in mood.

Fluctuations in ovarian hormones across the menstrual cycle have long been considered a determinant of mood in women. The majority of studies, however, use menstrual cycle phase as proxy for hormone levels. We measured ovarian hormone levels directly in order to examine the relationship between daily hormone levels and mood in non-help-seeking women. Participants (n=19) provided daily information about their positive and negative moods, and collected their first morning-voided urine for 42days, which was analyzed for estrogen and progesterone metabolites (E1G and PdG). The independent contributions of daily E1G, PdG, stress, physical health, and weekly social support, were calculated for 12 daily mood items, and composite measures of positive and negative mood items, using linear mixed models. E1G or PdG contributed to few mood items: E1G measured 2days prior contributed negatively to the model for Motivation, while E1G measured 3days prior contributed negatively to Getting Along with Others, and E1G measured 4days prior contributed negatively to Anxiety. PdG, measured the same day and 1day prior, contributed positively to the models of Irritability, and PdG measured 5days prior contributed positively to Difficulty Coping. By contrast, the variables stress and physical health contributed significantly to all the mood items, as well as both composite positive and negative mood measures. These findings demonstrate that, compared to stress and physical health, ovarian hormones make only a small contribution to daily mood. Thus, fluctuations in ovarian hormones do not contribute significantly to daily mood in healthy women.

Sleep medication in acute psychiatric illness: patient's knowledge and prescription patterns in New Zealand.

Adult patients (N = 100) being treated for acute psychiatric illness were interviewed about their sleep problems and attitudes toward available treatments. Most (74%) were using at least one prescribed psychotropic drug with hypnotic or sedative effects. Participants prescribed three or more drugs were less likely to name them correctly compared with those prescribed less. One quarter (24%) did not know that they were on a hypnosedative; more than half of those not prescribed a hypnosedative thought they were. Most participants found their medication effective; however, 54% wished to discontinue it. Two fifths of zopiclone users had been using it for more than 12 months. Although subjective sleep problems are very common in this patient group, they have limited accurate knowledge about their medication treatments. Many want to try alternative nonpharmacological ways to manage their sleep problems.

Experiences of Weight-Loss Surgery in People With Serious Mental Illness: A Qualitative Study.

BACKGROUND: Bariatric surgery is seldom accessed by people with serious mental illness, despite high rates of obesity in this population. It is sometimes assumed that patients with complex psychiatric histories will have poor post-surgical weight loss or exacerbation of psychiatric symptoms, although this is unsubstantiated. OBJECTIVES: A qualitative descriptive study to explore personal experiences and the impact of bariatric surgery on physical and mental well-being and life-quality in individuals with serious mental illness. METHODS: Nine adults with a history of bariatric surgery and concurrent severe depressive disorder, bipolar disorder, or schizoaffective disorder were interviewed about their experiences of bariatric surgery and its outcomes using semi-structured interview schedules. Data were transcribed and inductive thematic analysis undertaken. RESULTS: Five broad themes emerged: (1) surgery was highly effective for weight loss, and resulted in subjective improvements in physical health, quality of life, and mental health described as being able to live a life; (2) recovering from surgery was a tough road, notably in the post-operative period where negative sequelae often anteceded benefits; (3) post-operative support was important, but sometimes insufficient, including from families, mental health services, and surgical teams; (4) most considered surgery life-changing, recommending it to others with mental illness and obesity, two had different experiences; (5) participants considered it discriminatory that people with mental illness were not referred or declined weight loss surgery. CONCLUSIONS: Participants benefited from bariatric surgery and felt it should be offered to others with mental illness, but with additional care and support.

Crying as a gendered indicator of depression.

Crying is a gendered activity; women in the general population are known to cry more than men. However, crying is also used as a sign of depression. Its use may explain some of the discrepancy in rates of depression in men and women. We suggest that crying is an invalid indicator because of its gendered status and should be removed from the diagnostic criteria for depression. Men may show other symptoms when depressed more than women, such as aggression and irritability. The inclusion of crying items in depression instruments may therefore introduce a gender bias in the assessment of depression.

Becoming the best mom that I can: women's experiences of managing depression during pregnancy--a qualitative study.

BACKGROUND: The purpose of this constructivist grounded theory study was to develop a theoretical model that explains women's processes of managing diagnosed depression when pregnant. METHODS: We explored the experiences of 19 women in Ontario who were diagnosed with depression during their pregnancy. RESULTS: The model that emerged from the analysis was becoming the best mom that I can. Becoming the best mom that I can explains the complex process of the women's journey as they travel from the depths of despair, where the depression is perceived to threaten their pregnancy and their ability to care for the coming baby, to arrive at knowing the self and being in a better place. In order to reground the self and regain control of their lives, the women had to recognize the problem, overcome shame and embarrassment, identify an understanding healthcare provider, and consider the consequences of the depression and its management. When confronting and confining the threat of depression, the women employed strategies of overcoming barriers, gaining knowledge, and taking control. As a result of counseling, medication, or a combination of both, women felt that they had arrived at a better place. CONCLUSION: For many women, the idea that depression could occur during pregnancy was antithetical to their vision of the pregnant self. The challenge for a pregnant woman who is diagnosed with depression, is that effective care for her may jeopardize her baby's future health. This provides a dilemma for about-to-be parents and their healthcare providers. Improved awareness of depression during pregnancy on the part of healthcare professionals is needed to improve the women's understanding of this disorder and their ability to recognize and seek help with depression should it occur during the prenatal period. Further qualitative research is needed to determine the specific aspects that need to be addressed in such classes.

Gender differences in the symptoms of major depressive disorder.

Data from the Canadian Community Health Survey 1.2 were used for a gender analysis of individual symptoms and overall rates of depression in the preceding 12 months. Major depressive disorder was assessed using the Composite International Diagnostic Interview in this national, cross-sectional survey. The female to male ratio of major depressive disorder prevalence was 1.64:1, with n = 1766 having experienced depression (men 668, women 1098). Women reported statistically more depressive symptoms than men (p < 0.001). Depressed women were more likely to report "increased appetite" (15.5% vs. 10.7%), being "often in tears" (82.6% vs. 44.0%), "loss of interest" (86.9% vs. 81.1%), and "thoughts of death" (70.3% vs. 63.4%). No significant gender differences were found for the remaining symptoms. The data are interpreted against women's greater tendency to cry and to restrict food intake when not depressed. The question is raised whether these items preferentially bias assessment of gender differences in depression, particularly in nonclinic samples.

Crying, oral contraceptive use and the menstrual cycle.

BACKGROUND: Crying, a complex neurobiological behavior with psychosocial and communication features, has been little studied in relationship to the menstrual cycle. METHODS: In the Mood and Daily Life study (MiDL), a community sample of Canadian women aged 18-43 years, n=76, recorded crying proneness and crying frequency daily for six months along with menstrual cycle phase information. RESULTS: Crying proneness was most likely during the premenstruum, a little less likely during menses and least likely during the mid-cycle phase, with statistically significant differences although the magnitude of these differences were small. By contrast, actual crying did not differ between the three menstrual cycle phases. Oral contraceptive use did not alter the relationship between menstrual cycle phase and either crying variable. A wide range of menstrual cycle phase - crying proneness patterns were seen with visual inspection of the individual women's line graphs. LIMITATIONS: timing of ovulation was not ascertained. Using a three phase menstrual cycle division precluded separate late follicular and early luteal data analysis. The sample size was inadequate for a robust statistical test of actual crying. CONCLUSIONS: reproductive aged women as a group report feeling more like crying premenstrually but may not actually cry more during this menstrual cycle phase. Individual patterns vary substantially. Oral contraceptive use did not affect these relationships. Suggestions for future research are included.

Sleep quality and the menstrual cycle.

OBJECTIVE: This study aimed to assess the temporal relationship of subjective sleep quality to menstrual cycle phase in a community (non help-seeking) sample of adult women over six months. Previous work has produced contradictory results and often used student samples. PATIENTS/METHODS: This was a cohort study, using daily electronic data collection in the Greater Toronto Area, Ontario, Canada; 76 women aged 18-42 years recruited by random digit telephone dialing, recorded mood, sleep quality, and other health variables on a daily basis for 24 weeks. RESULTS: Using linear mixed models, we assessed the relationship between subjective sleep quality and three menstrual cycle phases (menses, premenstrual and midcycle) over 395 cycles. Premenstrual sleep quality was poorer than during the rest of the cycle, with a mean difference of 1.32 between premenstrual and midcycle reference phase, on a 1-100 quality scale (higher score denotes poorer quality). This difference held when the independent variables of daily exercise and physical health were added to the model; it became non-significant when perceived stress and later, social support were also added to the model. CONCLUSIONS: Sleep quality in adult non-help seeking women is statistically poorer in the premenstruum but the size of the difference is of little clinical significance and was no longer statistically significant with inclusion of the potentially confounding variables, perceived stress and social support.

Hypnosedative prescribing in outpatient psychiatry.

The objective of this study was to describe hypnosedative (HS) prescribing patterns in a typical sample of psychiatric outpatients. Prescription information was extracted from the clinical records of all current outpatients at two New Zealand public mental health centres. This included the type and duration of HS use and documentation of a clinical review of longstanding (>3 months) use, patient sex, age and ICD10 diagnoses. One-third of the patients (35.2%) were prescribed at least one HS; this was longstanding in two-thirds (69%). One in 10 had a coprescription of more than one HS drug. HS use was related to female sex and diagnosis, being more common among patients with nonpsychotic than psychotic disorders and very infrequent in patients on clozapine. In most longstanding cases, a clinical review had been documented. The logistic regression confirmed female sex, diagnosis and clozapine all as independent predictors of HS prescription. HS prescribing in psychiatric illness is more common than in the general population, often longstanding, with polypharmacy being common. The frequent use of antipsychotic drugs as HSs is of concern, given their side-effect profile. As there are risks involved with longstanding HS use, a better rationale for the role of medication in the management of sleep problems in psychiatric disorders is needed.

Women's perceptions of influences on their mood.

AIMS: Knowledge of prevailing community ideas about mood determination can guide research about variability in mood. A random sample of urban Canadian women, aged 18-40 years (n = 507), was asked to compare the relative importance of three specified domains (physical health, social support, stress) as influences on their mood and then to list additional life experiences they considered important. They also rated the frequency and recurrence patterns (cyclicity) of their daily positive and negative moods. RESULTS: More women reported a positive overall mood than negative mood. Of three domains studied, social support was listed as the greatest influence on positive mood and stress on negative mood in the bivariate tests. More frequent moods (both positive and negative) were more likely to be viewed as recurrent or cyclical. Patterns of influence for positive mood differed from those for negative mood. Multivariate modeling found that women reporting frequent positive mood were more often North American and employed full-time and likely to consider stress or lack of stress was unimportant as an influence on positive mood. The only factors in the model associated with frequent negative mood were the perception of physical health and stress as important influences on negative mood. Less than 5% cited menstrual cycle phase as an influence. CONCLUSIONS: These subjective data suggest that women perceived a wide range of external, usually interpersonal, influences as relevant to their mood, however menstrual cycle was rarely mentioned. Perceptions of influences on mood are statistically related to frequency of moods. In addition, ethnicity and paid employment are independently associated with positive mood.

Gender and psychotropic medication use: the role of intimate partner violence.

OBJECTIVE: Women are known to use more psychotropic medications than men which may be linked to women's greater exposure to intimate partner violence (IPV). METHOD: The use of medications for sleep, depression and anxiety in adults in the 1999 Canadian General Social Survey was assessed. Rates of medication use by adults exposed to IPV (physical, sexual, emotional and financial) were compared to rates of those reporting no IPV. RESULTS: More women (14.9%) than men (9.6%) reported use of psychotropic medications in the preceding month. Rates were significantly higher in both women and men who reported IPV. This link was still present after key sociodemographic and health predictors of medication use were held constant. CONCLUSION: This random population based study provides the first data to support the idea that IPV may explain at least some of the increased psychotropic medication use by women. IPV should be included as a predictor variable in future studies investigating psychotropic medication use which itself can be added to the list of adverse health risks of IPV.