Obesity and Related-factors in Patients with Chronic Mental Illness Registered to Community Mental Health Welfare Centers

Eun-Suk Park; Eun-Hyun Lee

doi:10.12799/jkachn.2018.29.1.76

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Park and Lee: Obesity and Related-factors in Patients with Chronic Mental Illness Registered to Community Mental Health Welfare Centers

Original Article

J Korean Acad Community Health Nurs 2018;29(1):76-86.

Published online: 12 March 2018

DOI: https://doi.org/10.12799/jkachn.2018.29.1.76

Obesity and Related-factors in Patients with Chronic Mental Illness Registered to Community Mental Health Welfare Centers

Eun-Suk Park¹, Eun-Hyun Lee²

¹Gunpo-si Community Mental Health Welfare Center, Gunpo, Korea

²Graduate School of Public Health, Ajou University, Suwon, Korea

Corresponding author: Lee, Eun-Hyun Graduate School of Public Health, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea. Tel: +82-31-219-5296, Fax: +82-31-219-5025, E-mail: ehlee@ajou.ac.kr

Received 22 September 2017 Revised 29 January 2018 Accepted 29 January 2018

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

The purpose of study was to examine the relationship between obesity and its associated factors (psychiatric symptom, duration of illness, type of medication, physical activity, dietary habits, depressive symptom, and stress) in patients with chronic mental illness registered to community mental health welfare centers.

Methods

This was a cross-sectional correlation study using a convenience sampling. A total of 392 participants were recruited from community mental health welfare centers. The obtained data were analyzed using binary and multinomial logistic regression.

Results

Atypical antipsychotic medication, duration of illness, dietary habits (overeating, and drinking instant coffee) were significantly contributed variables into body mass index (BMI) obesity. Atypical antipsychotic medication and instant coffee were significantly related to abdominal obesity.

Conclusion

These results emphasized the needs of tailored obesity-preventive management for the community-dwelling patients with chronic mental illness, topically focusing on the administration of atypical antipsychotic medication, duration of illness, and dietary habits.

Keywords: Mental disorders, Obesity, Depression, Diet, Psychological stress

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Table 1.

General Characteristics and Their Associations with BMI and Abdominal Obesity (N=392)

Characteristics	Categories	n (%)	BMI obesity					Abdominal obesity
			Normal	Overweight	Obesity	Severe obesity	x² (p)	Normal	Obesity	x² (p)
			n (%)	n (%)	n (%)	n (%)	x² (p)	n (%)	n (%)	x² (p)
Gender	Male	234 (59.7)	59 (25.2)	67 (28.6)	77 (32.9)	31 (13.2)	10.88	97 (41.5)	137 (58.5)	19.20
	Female	158 (40.3)	54 (34.2)	25 (15.8)	50 (31.6)	29 (18.4)	(.012)	32 (20.3)	126 (79.7)	(＜.001)
Age (year)	≤29	47 (12.0)	22 (46.8)	8 (17.0)	9 (19.1)	8 (17.0)	13.03	28 (59.6)	19 (40.4)	19.65
	30~39	95 (24.2)	22 (23.2)	26 (27.4)	30 (31.6)	17 (17.9)	(.161)	32 (33.7)	63 (66.3)	(＜.001)
	40~49	126 (32.2)	31 (24.6)	30 (23.8)	46 (36.5)	19 (15.1)		39 (31.0)	87 (69.0)
	≥50	124 (31.6)	38 (30.6)	28 (22.6)	42 (33.9)	16 (12.9)		30 (24.2)	84 (75.8)
Education level	Elementary school	35 (8.9)	7 (20.0)	10 (28.6)	14 (40.0)	4 (11.4)	5.56	7 (20.0)	28 (80.0)	3.39
	Middle school	58 (14.8)	15 (25.9)	17 (29.3)	17 (29.3)	9 (15.5)	(.783)	18 (31.0)	40 (69.0)	(.335)
	High school	220 (56.2)	68 (30.9)	44 (20.0)	72 (32.7)	4 (11.4)		78 (35.5)	142 (64.5)
	≥College Missing	2 (0.5)	23 (29.9)	20 (26.0)	23 (29.9)	11 (14.3)		25 (32.5)	52 (67.5)
Marital status	Single	284 (72.4)	85 (29.9)	67 (23.6)	95 (33.5)	37 (13.0)	8.59	104 (36.6)	180 (63.4)	8.06
	Married	42 (11.0)	8 (18.6)	8 (18.6)	17 (39.5)	10 (23.3)	(.198)	13 (30.2)	30 (69.8)	(.018)
	Divorced	65 (16.6)	20 (30.8)	17 (26.2)	15 (23.1)	13 (20.0)		12 (18.5)	53 (81.5)
Monthly income (10,000 won)	＜100	239 (61.0)	66 (27.6)	59 (24.7)	81 (33.9)	33 (13.8)	2.23 (.527)	75 (31.4)	164 (68.6)	0.65
	≥100	150 (38.2)	46 (30.7)	33 (22.0)	44 (29.3)	27 (18.0)	(.527)	53 (35.3)	97 (64.7)	(.419)
	Missing	3 (0.8)
Health insurance status	Health insurance	216 (55.1)	60 (27.8)	51 (23.6)	69 (31.9)	36 (16.7)	0.80	75 (34.7)	141 (65.3)	0.72
Health insurance status	Medical aid	176 (44.9)	53 (30.1)	41 (23.3)	58 (33.0)	24 (13.6)	(.849)	54 (30.7)	122 (69.3)	(.397)
Smoking	No smoking	248 (63.3)	75 (30.2)	53 (21.4)	82 (33.1)	38 (15.3)	1.83	74 (29.8)	174 (70.2)	2.88
Smoking	Smoking	144 (36.7)	38 (26.4)	39 (27.1)	45 (31.3)	22 (15.3)	(.609)	55 (38.2)	89 (61.8)	(.090)
Alcohol	No drinking for a year	262 (66.8)	81 (30.9)	60 (22.9)	86 (32.8)	35 (13.4)	5.85	84 (32.1)	178 (67.9)	0.73
	≤4 times/month	108 (27.6)	28 (25.9)	27 (25.0)	31 (28.7)	22 (20.4)	(.440)^†	36 (33.3)	72 (66.7)	(.694)
	≥5 times/month	22 (5.6)	4 (18.2)	5 (22.7)	10 (45.5)	3 (13.6)		9 (40.9)	13 (59.1)
Diagnosis	Schizophrenia	346 (88.3)	96 (27.7)	87 (25.1)	110 (31.8)	53 (15.3)	6.29	112 (32.4)	234 (67.6)	1.16
	Bipolar disorder	20 (5.1)	6 (30.0)	2 (10.0)	8 (40.0)	4 (20.0)	(.391)^†	6 (30.0)	14 (70.0)	(.559)
	Depression	26 (6.6)	11 (42.3)	3 (11.5)	9 (34.6)	3 (11.5)		11 (42.3)	15 (57.7)
Drug compliance	Daily taking	365 (90.8)	101 (28.4)	88 (24.7)	115 (32.3)	52 (14.6)	4.11	119 (33.4)	237 (66.6)	0.47
Drug compliance	Non daily taking	36 (9.2)	12 (33.3)	4 (11.1)	12 (33.3)	8 (22.2)	(.250)	10 (27.8)	26 (72.2)	(.492)

^† Fisher's exact test.

Table 2.

Descriptive Statistics for the Study Variables. (N=392)

Variables	Categories		n(%)	M±SD	Range
BMI obesity	Normal weight		113 (28.8)
	Overweight Obesity		92 127 (23.5) (32.4)
	Severe obesity		60 (15.3)
Abdominal obesity	No		129 (32.9)
Abdominal obesity	Yes (obesity)		263 (67.1)
Psychiatric symptom				36.4±11.5	7~77
Duration of illness (year)	＜5		41 (10.5)	16.8±10.1	0~45
	5~10		81 (20.7)
	＞10		270 (68.8)
Antipsychotics	Others		187(47.7)
	Atypical (Risperidone, Clozapine, Olanzapine, Quetiapine, Duplicate medication)		205(52.3)
Physical activity	Active		137 (34.9)	27.5±26.0	0~148
	Moderate		76 (19.4)
	Insufficiently active		179 (45.7)
Dietary habits	Amount of food	Very full	53 (13.5)
		A little bit full Moderate	116 178 (29.6) (45.4)
		Somewhat insufficient	45 (11.5)
	Time spent eating (minute)	＜10	122 (31.1)
		10~20	201 (51.3)
		20~30	54 (13.8)
		＞30	15 (3.8)
	Overeating	Daily	18 (4.6)
		5~6 times/week	24 (6.1)
		3~4 times/week	43 (11.0)
		1~2 times/week	112 (28.6)
		Almost no	195 (49.7)
	Soft drinks consumption	≥5 times/week	27 (6.9)
		3~4 times/week	55 (14.0)
		1~2 times/week	95 (24.2)
		1~3 times/month	47 (12.0)
		Almost no	168 (42.9)
	Instant coffee consumption	≥5 times/week	123 (31.4)
		3~4 times/week	64 (16.3)
		1~2 times/week	86 (21.9)
		1~3 times/month	27 (6.9)
		Almost no	92 (23.5)
Depression	Normal		133 (33.9)	7.9±5.8	0~27
	Mild Moderate		124 120 (31.7) (30.6)
	Severe		15 (3.8)
Stress				11.7±4.7	5~25

Table 3.

Multinominal Logistic Regression Analysis: BMI Obesity and Related Study Variables (N=392)

Variables	Characteristics	Categories	Model 1(Reference group: normal)									Model 2(Reference group: normal)
			Overweight			Obesity			Severe obesity			Overweight			Obesity			Severe obesity
			OR	95% CI	p	OR	95% CI	p	OR	95% CI	p	OR	95% CI	p	OR	95% CI	p	OR	95% CI	p
Socio demographic factors	Gender	(Male) Female	0.41	0.23~0.74	.003	0.71	0.43~1.19	.190	1.02	0.55~1.91	.945	0.40	0.21~0.75	.004	0.86	0.48~1.52	.601	1.27	0.60~2.69	.542
Illness-specific and psychotropic medication factors	Psychiatric symptom											1.00	0.97~1.03	.873	1.01	0.98~1.03	.500	1.02	0.99~1.05	.312
	Duration of illness (year)	(＜5)
		5~10										0.62	0.22~1.72	.355	1.77	0.61~5.11	.293	4.36	0.76~25.10	.099
		>10										1.27	0.54~3.00	.579	3.27	1.28~8.37	.013	5.88	1.15~29.98	.033
	Antipsychotics	(Others) Atypical										1.99	1.07~3.70	.029	1.20	0.68~2.12	.520	1.37	0.65~2.89	.411
Lifestyle factors	Physical activity	(Activity)
		Insufficiently active										1.19	0.60~2.35	.618	0.74	0.40~1.37	.338	0.94	0.40~2.22	.883
		Moderate										0.94	0.39~2.31	.901	1.24	0.56~2.74	.600	1.72	0.61~4.84	.307
	Dietary habits
	Amount of food	(Somewhat insufficient)
		Very full A little bit full										1.18 1.05	0.33~4.28 0.37~2.99	.800 .933	1.80 1.42	0.55~5.87 0.53~3.84	.332 .488	1.56 2.26	0.36~6.76 0.65~7.89	.549 .202
		Moderate										1.08	0.42~2.78	.869	1.26	0.50~3.16	.626	1.31	0.38~4.53	.669
	Time spent eating (minute)	(＞30)
		＜10										1.36	0.28~6.74	.704	3.53	0.74~16.85	.114	2.38	0.34~16.93	.386
		10~20
		20~30										1.72 1.77	0.36~8.19 0.33~9.65	.495 .509	2.61 2.19	0.56~12.25 0.41~11.71	.222 .360	2.27 4.21	0.34~15.23 0.54~32.70	.400 .169
	Overeating	(Almost no)
		Daily										2.16	0.29~16.01	.452	1.95	0.30~12.50	.482	20.45	2.81~148.96	.003
		5~6 times/week										1.98	0.45~8.79	.371	1.92	0.49~7.56	.349	5.62	1.12~28.18	.036
		3~4 times/week
		1~2 times/week										1.41	0.66~3.01	.380	1.21	0.60~2.46	.593	3.15	1.23~8.06	.017
	Soft drinks consumption	(Almost no)
		≥5 times/week										0.43	0.11~1.75	.240	0.91	0.30~2.80	.876	0.26	0.05~1.33	.105
		3~4 times/week										0.83	0.36~1.90	.661	1.60	0.76~3.34	.214	0.65	0.24~1.77	.400
		1~2 times/week										0.83	0.36~1.90	.661	1.60	0.76~3.34	.214	0.65	0.24~1.77	.400
		1~3 times/month										1.27	0.50~3.22	.613	0.78	0.30~2.01	.602	0.35	0.10~1.31	.119
	Instant coffee consumption	(Almost no)
		≥5 times/week										1.17	0.52~2.62	.708	1.85	0.86~3.96	.115	10.45	2.53~43.09	.001
		3~4 times/week										0.72	0.30~1.73	.465	0.99	0.43~2.26	.978	7.41	1.75~31.36	.006
		1~2 times/week										0.72	0.30~1.73	.465	0.99	0.43~2.26	.978	7.41	1.75~31.36	.006
		1~3 times/month										0.26	0.05~1.47	.128	1.55	0.51~4.72	.443	6.63	1.05~41.99	.044
Psychological factors	Depression	(Normal)
		Severe										0.54	0.04~8.10	.657	2.66	0.38~18.67	.324	4.07	0.43~38.24	.220
		Moderate Mild										0.95 1.00	0.36~2.47 0.46~2.18	.910 1.000	0.85 1.04	0.36~2.04 0.51~2.13	.724 .916	0.62 1.57	0.19~2.01 0.62~4.00	.424 .346
	Stress											1.01	0.93~1.10	.811	0.98	0.91~1.06	.596	0.98	0.88~1.09	.675
			x²=11.15, p＜.001									x²=132.07, p＜.001

Table 4.

Logistic Regression Analysis: Abdominal Obesity and Related Study Variables (N=392)

Variables	Characteristics	Categories	Model 1				Model 2
Variables	Characteristics	Categories	b	p	OR	95% CI	b	p	OR	95% CI
(Constant)			-0.80				-1.35
Socio demographic factors	Gender	(Male)
		Female	1.00	＜.001	2.72	1.64~4.52	1.23	＜.001	3.43	1.94~6.07
	Age(year)	(≤29)
		30~39	1.14	.003	3.13	1.48~6.59	1.02	.023	2.77	1.15~6.67
		40~49	1.28	.001	3.59	1.73~7.45	1.13	.013	3.11	1.27~7.60
		≥50	1.50	＜.001	4.47	2.08~9.60	1.62	.001	5.06	1.89~13.50
	Marital status	Single
		Married	-0.21	.577	0.81	0.38~1.71	-0.16	.701	0.85	0.38~1.93
		Divorced	0.27	.469	1.32	0.63~2.76	0.27	.512	1.32	0.58~2.98
Illness-specific and psychotropic medication factors	Psychiatric symptom						0.01	.605	1.01	0.98~1.03
	Duration of illness (year)	(＜5)
		5~10					0.25	.583	1.28	0.53~3.08
		＞10					0.49	.249	1.63	0.71~3.72
	Antipsychotics	(Others) Atypical					0.51	.049	1.67	1.00~2.77
Lifestyle factors	Physical activity	(Active)
		Insufficiently activity					0.13	.651	1.14	0.65~2.00
		Moderate					0.33	.352	1.39	0.70~2.76
Dietary habits
	Amount of food	(Somewhat insufficient)
		Very full					0.11	.837	1.12	0.39~3.17
		A little bit full					0.30	.497	1.35	0.57~3.25
		Moderate					-0.08	.846	0.92	0.41~2.07
	Time spent eating (minute)	(＞30)
		＜10					-0.48	.572	0.62	0.12~3.29
		10~20					-0.86	.306	0.42	0.08~2.20
		20~30					-1.28	.148	0.28	0.05~1.58
	Overeating	(Almost no)
		Daily					-0.05	.941	0.95	0.26~3.52
		5~6 times/week					1.02	.091	2.77	0.85~9.02
		3~4 times/week					0.67	.160	1.95	0.77~4.92
		1~2 times/week					0.30	.356	1.35	0.72~2.54
	Soft drinks	(Almost no)
		≥5 times/week					0.34	.540	1.40	0.47~4.16
		3~4 times/week					0.14	.734	1.15	0.51~2.61
		1~2 times/week					0.40	.239	1.49	0.77~2.90
		1~3 times/month					-0.33	.413	0.72	0.33~1.58
	Instant coffee mixes	(Almost no)
		≥5 times/week					0.71	.046	2.03	1.01~4.09
		3~4 times/week					0.21	.604	1.23	0.56~2.73
		1~2 times/week					-0.06	.866	0.94	0.46~1.94
		1~3 times/month					0.62	.275	1.85	0.61~5.62
Psychological factors	Depression	(Normal)
		Severe					0.52	.535	1.68	0.33~8.64
		Moderate					0.44	.282	1.55	0.70~3.44
		Mild					0.04	.893	1.04	0.56~1.94
	Stress						-0.04	.255	0.96	0.89~1.03
			x²=38.99, p＜.001				x²=75.85, p＜.001

OR=odds ratio: CI=confidence interval.

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