The Effects of an Integrated Health Care Program on the Physical, Psychosocial, and Spiritual Health of People with Mental Disorder in Community

Gwang Ha Jung; Young Ran Chin

doi:10.12799/jkachn.2015.26.2.69

Journal List > J Korean Acad Community Health Nurs > v.26(2) > 1058406

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jung and Chin: The Effects of an Integrated Health Care Program on the Physical, Psychosocial, and Spiritual Health of People with Mental Disorder in Community

Original Article

Journal of Korean Academy of Community Health Nursing 2015; 26(2): 69-78.

Published online: 30 June 2015

DOI: https://doi.org/10.12799/jkachn.2015.26.2.69

The Effects of an Integrated Health Care Program on the Physical, Psychosocial, and Spiritual Health of People with Mental Disorder in Community

Gwang Ha Jung¹, Young Ran Chin²

¹Somangnamu Community Mental Rehabilitation Center, Seoul, Korea.

²Department of Nursing, Chungwoon University, Hongseong, Korea.

Corresponding author: Chin, Young Ran. Department of Nursing, Chungwoon University, 25 Daehak-gil, Hongseong-eup, Hongseong 350-701, Korea. Tel: +82-41-630-3408, Fax: +82-41-630-3303, chinyoungran@hanmail.net

Received 9 January 2015 Revised 21 March 2015 Accepted 13 May 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted in order to investigate changes in the physical, psychosocial and spiritual health of people with mental disorder in community participating in the Integrated Health Care Program (IHCP).

Methods

This study applied the non-equivalent control group pretest-posttest quasi-experimental design. The participants were 37 chronic psychiatric patients who had been clinically diagnosed with mental disorder and visiting a mental rehabilitation center located in S City (17 in the experimental group, and 20 in the control group). The experimental group participated in the IHCP consisting of 24 sessions for eight weeks.

Results

After the intervention, only the participants in the experimental group reported significant improvement in physical (body mass, triglyceride), psychosocial (mental symptoms, depression, self-esteem, ability of problem solving), and spiritual wellbeing when compared with those in the control group.

Conclusion

These results indicate that IHCP is effective in improving the physical, psychosocial, and spiritual wellbeing of people with mental disorder. Therefore, IHCP developed in this study is considered a useful nursing intervention for raising the comprehensive health level of people with mental disorder in community.

Keywords: Psychiatric nursing, Complementary therapies, Mind-body therapies, Sensory art therapies, Exercise

Figures and Tables

Figure 1

The design of this study.

Figure 2

Conceptual framework.

Table 1

Contents of Integrated Health Promotion Program

Week	Sessions	Physical (60 mins)	Psychosocial (60 mins)		Spiritual (60 mins)
Week	Sessions	Topics/contents	Topics	Contents and activity	Topics	Contents and activity
1	1	Physical exercise/stretching → Aerobic exercising → Anaerobic exercising	Social relation	Understanding of program	Meaning and purpose of life	Couple prayer/
	2		Laughter			Seeking empirical values
	3		Art			Intercessory prayer/
						Meaning of Life
						Changing stance of life
2	4		Social relation	Training on ice-breaking		Purpose of life
	5		Laughter	Humor quiz		Seeking values of future
	6		Art	Painting for self introduction		Hugging/rebuilding meaning and goals of life
3	7		Social relation	Saying confirmation question	Strengthening love and relations	Couple prayer/ Who am I?
	8		Laughter	Smile, Greeting, Conversation Praise		My merits and demerits
	9		Art	Painting on first impression		Understanding another persons
4	10		Social relation	Training on social situational understanding (1)		Rating value of life
	11		Laughter	Laughter training		Outcast experience and confidence games
	12		Art	Painting with left hand		Love basket
5	13		Social relation	Training on social situational understanding (2)	Sharing forgiveness	Couple prayer/
	14		Laughter	Laughter of Snow White		Recognizing and expressing rage and
	15		Art	Clay arts		Intercessory prayer/
						Forgiveness
						Placing myself in other's place
6	16		Social relation	Seeking problems		Beyond halter of sentiment
	17		Laughter	Laughter make-up		Beyond halter of rage
	18		Art	Finger painting		From healing to spiritual
	18		Art	Finger painting		maturation
7	19		Social relation	Solving problems (1)	Seeking hope	Couple prayer/
	20		Laughter	Applause mingled with		Positive thinking
	21			laughter		Intercessory prayer/
			Art	Orchid with Chinese ink		Hope image
			Art	Orchid with Chinese ink		Writing diary of success
8	22		Social relation	Solving problems (2)		Postcard of hope
	23		Laughter	Self change		Enhancing hope
	24		Art	Painting harmony tree		Intercessory prayer/
	24		Art	Painting harmony tree		Hugging and accepting myself

Table 2

Homogeneity of General Characteristics and Dependent Variables

Variables	Characteristics	Categories	Exp. (n=17)	Cont. (n=20)	x² or t	p
Variables	Characteristics	Categories	n (%)/M±SD	n (%)/M±SD	x² or t	p
General characteristics	Gender	Male	5 (29.4)	7 (35.0)	0.13	.717
	Gender	Female	12 (70.6)	13 (65.0)	0.13	.717
	Age (year)	≤29	6 (35.3)	7 (35.0)	0.05	.997
		30~49	7 (41.2)	8 (40.0)
		≥50	4 (23.5)	5 (25.0)
	Marriage	Unmarried	13 (76.5)	13 (65.0)	3.28	.512
		Divorced	3 (17.6)	6 (30.0)
		Married	1 (5.9)	1 (5.0)
	Education	≤Middle school	3 (17.7)	3 (15.0)	2.96	.398
		High school	10 (58.8)	12 (60.0)
		College or University	4 (23.5)	5 (13.5)
	Length of care (year)	1~5	8 (48.1)	6 (30.0)	2.11	.673
		6~10	0 (0.0)	2 (10.0)
		≥10	9 (52.9)	12 (60.0)
	Medical diagnosis	Obsessive compulsive disorder	0 (0.0)	1 (5.0)	1.13	.738
		Schizophrenia	15 (88.2)	17 (85.0)
		Affective disorder	2 (11.8)	2 (10.0)
	Onset age of mental disease	≤19	5 (29.4)	4 (20.0)	3.25	.354
		20~29	8 (47.1)	10 (50.0)
		30~39	4 (23.5)	3 (15.0)
		≥40	0 (0.0)	3 (15.0)
	Religion	None	4 (23.5)	4 (20.0)	7.94	.147
		Christian	8 (47.1)	12 (60.0)
		Catholic	5 (29.4)	3 (15.0)
		etc.	0 (0.00)	1 (5.0)
Physical health		Body mass	26.3±4.68	25.3±4.50	0.69	.495
		Triglyceride	148.4±79.24	126.6±69.18	0.89	.377
		HDL-cholestrol	36.6±0.24	41.2±2.73	-1.20	.239
		BMI (body mass index)	33.3±8.33	32.5±9.04	0.26	.799
		Abdominal fat ratio	0.9±0.03	0.9±0.05	-0.68	.502
Psycho-social health		Mental symptoms	53.4±6.62	52.1±8.83	0.52	.608
		Depression	15.7±6.98	15.4±6.01	0.14	.890
		Self-esteem	27.8±4.92	27.2±4.80	0.42	.677
		Ability of problem solving	102.0±10.05	103.4±9.93	-0.41	.684
Spiritual health		Spiritual well-being	51.2±7.95	50.2±9.49	0.37	.712

Exp.=experimental group; Cont.=control group; BMI=body mass index.

Table 3

Differences in Dependent Variables between Experimental and Control Groups

Variables	Categories	Group	Exp. (n=17)	Cont. (n=20)	Difference	paired-t	p	Source	F	p
Variables	Categories	Group	M±SD	M±SD	M±SD	paired-t	p	Source	F	p
Physical health	Body mass	Exp.	26.3±4.68	25.9±4.74	0.4±0.44	2.18	.036^†	Group	0.13	.718
		Cont.	25.3±4.50	25.1±4.49	0.1±0.47			Time	6.28	.017
		Cont.	25.3±4.50	25.1±4.49	0.1±0.47			G×T	1.81	.188
	Triglyceride	Exp.	148.4±79.24	134.8±69.45	13.6±46.24	2.46	.019^†	Group	0.01	.928
		Cont.	126.6±69.18	152.9±81.05	-26.3±51.51			Time	0.90	.349
		Cont.	126.6±69.18	152.9±81.05	-26.3±51.51			G×T	8.87	.005
	HDL-cholesterol	Exp.	36.6±10.24	35.6±10.64	1.0±6.75	-0.74	.462	Group	1.58	.217
		Cont.	41.2±12.73	38.9±9.33	2.3±4.19			Time	9.53	.004
		Cont.	41.2±12.73	38.9±9.33	2.3±4.19			G×T	1.51	.227
	BMI	Exp.	33.3±8.33	33.7±7.37	-0.4±1.75	-0.70	.487	Group	0.36	.555
		Cont.	32.5±9.04	32.7±8.79	-0.1±0.86			Time	6.33	.017
		Cont.	32.5±9.04	32.7±8.79	-0.1±0.86			G×T	2.77	.105
	Abdominal fat ratio	Exp.	0.9±0.03	0.9±0.04	0.0±0.02	-0.70	.487	Group	0.16	.289
		Cont.	0.9±0.05	0.9±0.05	0.0±0.01			Time	3.73	.062
		Cont.	0.9±0.05	0.9±0.05	0.0±0.01			G×T	3.73	.062
Psycho-social health	Mental symptoms	Exp.	53.4±6.62	49.7±5.38	3.7±3.10	2.45	.020^†	Group	0.22	.642
		Cont.	52.1±8.83	50.1±9.04	2.0±1.32			Time	6.37	.016
		Cont.	52.1±8.83	50.1±9.04	2.0±1.32			G×T	3.07	.089
	Depression	Exp.	15.7±6.98	14.1±7.16	1.5±1.23	5.41	<.001^†	Group	0.23	.637
		Cont.	15.4±6.01	16.5±7.01	-1.2±1.73			Time	0.16	.691
		Cont.	15.4±6.01	16.5±7.01	-1.2±1.73			G×T	8.00	.008
	Self esteem	Exp.	27.8±4.92	28.3±4.59	-0.5±0.77	-2.12	.041^†	Group	0.44	.510
		Cont.	27.2±4.80	27.0±4.87	0.2±1.10			Time	0.09	.773
		Cont.	27.2±4.80	27.0±4.87	0.2±1.10			G×T	0.52	.475
	Ability of problem solving	Exp.	102.0±10.05	104.9±9.46	-2.9±2.11	-3.38	.002^†	Group	0.00	.959
		Cont.	103.4±9.93	103.9±9.37	-0.5±2.14			Time	3.59	.069
		Cont.	103.4±9.93	103.9±9.37	-0.5±2.14			G×T	1.75	.194
Spiritual health	Spiritual wellbeing	Exp.	51.2±7.95	55.6±8.44	-4.4±3.77	-3.41	.002^†	Group	1.49	.230
		Cont.	50.2±9.49	50.0±10.84	0.2±4.20			Time	2.10	.149
		Cont.	50.2±9.49	50.0±10.84	0.2±4.20			G×T	2.50	.123

Exp.=experimental group; Cont.=control group; BMI=body mass index; ^†ANCOVA with pretest value as covariate; ^‡Multivariate tests.

References

1. Jo MJ, Bae A, Bae JN, Son JW, Ahn JH, Lee DW, et al. The epidemiological survey of mental disorders in Korea. Seoul: Ministry of Health and Welfare;2012. p. 227.

2. Nordentoft M, Wahlbeck K, Hällgren J, Westman J, Osby U, Alinaghizadeh H, et al. Excess mortality, causes of death and life expectancy in 270,770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLoS One. 2013; 8(1):e55176. DOI: 10.1371/journal.pone.0055176.

3. Krane-Gartiser K, Breum L, Glümer C, Linneberg A, Madsen M, Køster A. Prevalence of the metabolic syndrome in Danish psychiatric outpatients treated with antipsychotics. Nord J Psychiatry. 2011; 65(5):345–352. DOI: 10.3109/08039488.2011.565799.

4. Krogh J, Speyer H, Nørgaard HCB, Moltke A, Nordentoft M. Can exercise increase fitness and reduce weight in patients with schizophrenia and depression? Front Psychiatry. 2014; 5:89. DOI: 10.3389/fpsyt.2014.00089.

5. Grover S, Davuluri T, Chakrabarti S. Religion, spirituality, and schizophrenia: A review. Indian J Psychol Med. 2014; 36(2):119–124. DOI: 10.4103/0253-7176.130962.

6. Ko MS, Kim TS, Min S, Park JS, Yeom YH. Introduction to nursing. 3rd ed. Seoul: Soomoonsa;2011. p. 536.

7. Roder V, Mueller DR, Schmidt SJ. Effectiveness of integrated psychological therapy (IPT) for schizophrenia patients: A research update. Schizophr Bull. 2011; 37:Suppl 2. S71–S79. DOI: 10.1093/schbul/sbr072.

8. Bennett MP. Multidimensional factors affecting wellbeing: A model of multi-level nursing practice [dissertation]. [Indiana]: Indiana State University;2002. 198.

9. Oh KO. The effect of aerobic exercise on chronic schizophrenia. J Korean Acad Nurs. 1994; 24(1):5–17.

10. Chung KS. Effects of group art therapy program on self-esteem and mental health status in chronic schizophrenic Inpatients. J Korean Acad Nurs. 1999; 29(6):1314–1323.

11. Kim YS, Choi YB. The revised guideline for the obesity management. Seoul: Korean Society for the Study of Obesity;2012. p. 198.

12. Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962; 10(3):799–812. DOI: 10.2466/pr0.1962.10.3.799.

13. Song MS, Kim SM, Kim JI, Cho NO. Measurement in gerontology research. Seoul: Hana Publication;2007. p. 435.

14. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4(6):561–571. DOI: 10.1001/archpsyc.1961.01710120031004.

15. Lee YH, Song JY. A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean J Clin Psychol. 1991; 10(1):98–113.

16. Heppner PP, Peterson CH. The development implications of a personal problem-solving inventory. J Couns Psychol. 1982; 29(1):66–75. DOI: 10.1037/0022-0167.29.1.66.

17. Jeon SK. A study on the effectiveness of social skills training program for rehabilitation of the schizophrenic patients [dissertation]. [Seoul]: Soongsil University;1995. 178.

18. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press;1965. p. 326.

19. Jon BJ. Self-esteem: A test of its measurability. Yonsei Nonchong. 1974; 11(1):107–130.

20. Ellison CW. Spiritual well-being: Conceptualization and measurement. J Psychol Theol. 1983; 11(4):330–340.

21. Choi SS. A correlational study on spiritual wellness, hope and perceived health status of urban adult [dissertation]. [Seoul]: Yonsei University;1991. 81.

22. Fisher S, Shelly JA. Spiritual care: The nurse's role. Illinois: Inter Varsity Press;1988. p. 251.

23. Zschucke E, Gaudlitz K, Ströhle A. Exercise and physical activity in mental disorders: Clinical and experimental evidence. J Prev Med Public Health. 2013; 46:Suppl 1. S12–S21. DOI: 10.3961/jpmph.2013.46.S.S12.

24. Vancampfort D, Probst M, Skjaerven LH, Catalan-Matamoros D, Lundvik-Gyllensten A, Gomez-Conesa A, et al. Systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia. Phys Ther. 2012; 92(1):11–23. DOI: 10.2522/ptj.20110218.

25. Pearsall R, Smith DJ, Pelosi A, Geddes J. Exercise therapy in adults with serious mental illness: A systematic review and meta-analysis. BMC Psychiatry. 2014; 14:117. DOI: 10.1186/1471-244X-14-117.

26. Kukkonen-Harjula KT, Borg PT, Nenonen AM, Fogelholm MG. Effects of a weight maintenance program with or without exercise on the metabolic syndrome: A randomized trial in obese men. Prev Med. 2005; 41(3-4):784–790. DOI: 10.1016/j.ypmed.2005.07.008.

27. Kwon JH, Koh Y. A preliminary study on the effectiveness of social-cognition enhancing rehabilitation program. Korean J Clin Psychol. 2002; 21(2):281–292.

28. Crawford MJ, Patterson S. Arts therapies for people with schizophrenia: An emerging evidence base. Evid Based Ment Health. 2007; 10(3):69–70. DOI: 10.1136/ebmh.10.3.69.

29. Ko HJ, Youn CH. Effects of laughter therapy on depression, cognition and sleep among the community-dwelling elderly. Geriatr Gerontol Int. 2011; 11(3):267–274. DOI: 10.1111/j.1447-0594.2010.00680.x.

TOOLS

Similar articles