Self-Reported Nutrition and Physical Activity Program Utilisation among Australians with Psychosis: A Cross-Sectional Analysis of Data

Doreen Mucheru; Mary-Claire Hanlon; Linda E. Campbell; Mark McEvoy; Lesley MacDonald-Wicks

Journal of Community Medicine & Public Health

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Self-Reported Nutrition and Physical Activity Program Utilisation among Australians with Psychosis: A Cross-Sectional Analysis of Data

Doreen Mucheru^1*, Mary-Claire Hanlon^1,2, Linda E. Campbell^2,3, Mark McEvoy^1,4, Lesley MacDonald-Wicks^1,5

¹Faculty Health and Medicine, The University of Newcastle, Australia

²Brain and Mental Health Program, Hunter Medical Research Institute, Australia

³Faculty of Science, The University of Newcastle, Australia

⁴Centre for Clinical Epidemiology & Biostatistics, Hunter Medical Research Institute, Australia

⁵Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Australia

^*Corresponding author: Doreen Mucheru, Faculty of Health and Medicine, The University of Newcastle, Callaghan NSW 2308, Australia. Tel: +61-249854928; Email: Doreen.Mucheru@uon.edu.au

Received Date: 06 June, 2019; Accepted Date: 21 June, 2019; Published Date: 27 June, 2019

Citation: Mucheru D, Hanlon MC, Campbell LE, McEvoy M, MacDonald-Wicks L (2019) Self-Reported Nutrition and Physical Activity Program Utilisation among Australians with Psychosis: A Cross-Sectional Analysis of Data. J Community Med Public Health 3: 155. DOI: 10.29011/2577-2228.100055

Abstract

Objective: To describe the self-reported attendance of community nutrition and physical activity programs in the government and non-government sector among 1825 people from the Survey of High Impact Psychosis (SHIP), and identify demographics associated with overall self-reported program attendance. Additionally, to assess whether improved nutrition and physical activity outcomes were associated with program attendance.

Methods: In this cross-sectional analysis of data from SHIP, descriptive statistics were generated and tests-of-association applied between program attendance, and demographics, nutrition and physical activity outcomes.

Results: Just 11.6% attended a nutrition or physical activity program. Overall attendance was associated with highest education qualifications attained (p=0.004) and diagnosed disorder (p=0.022). Non-government sector attendees were more likely to consume reduced fat milk (p=0.010), and less likely to run out of food (p=0.007).

Conclusions: There is extremely low utilisation of community nutrition and physical activity programs in Australians with psychosis which is associated with certain demographics that may act as barriers. Program attendance did not show consistent association with improved nutrition or physical activity outcomes.

Implications for public health: Nutrition and physical activity program utilisation should be encouraged in people with psychosis by addressing problems related to access. These programs should be evaluated locally to ensure usefulness.

Keywords: Community programs; Nutrition; Physical activity; Psychosis

Total Sample

N = 1825

(N %) or

M (SD)

Attended Nutrition and Physical Activity Program in any Sector

n = 212

(n %) or

M (SD)

Did not Attend Nutrition and Physical Activity Program any Sector

n = 509

(n %) or

M (SD)

Test

Sex

Male

1087

(59.6%)

129

(60.8%)

298

(58.5%)

X²= 0.329, df= 1, p = 0.566

Female

738

(40.4%)

(39.2%)

211

(41.5%)

Age

38.4

(11.2)

40.0

(11.2)

38.6

(11.1)

t=-1.590, df=719, p=0.693

Aboriginal/ Torres Strait Islander descent

1735

(95.1%)

202

(95.3%)

479

(94.1%)

X²= 0.396, df= 1, p = 0.529

Yes

(4.9%)

(4.7%)

(5.9%)

Marital status

Single/ Never Married

1117

(61.2%)

137

(64.6%)

341

(67.0%)

X²= 2.527, df= 3, p = 0.470

Married/ De facto

312

(17.1%)

(10.4%)

(11.2%)

Separated/ Divorced

376

(20.6%)

(21.7%)

103

(20.2%)

Widowed

(1.1%)

(3.3%)

(1.6%)

Highest education qualification attained

Left school with no qualifications

615

(33.7%)

(25.5%)

208

(40.9%)

X²=17.394, df= 5, **p = 0.004

Secondary school qualifications

304

(16.7%)

(21.7%)

(15.3%)

Tertiary Qualifications

739

(40.5%)

(44.3%)

178

(35.0%)

Bachelor degree

(5.0 %)

(4.7%)

(4.3%)

Postgraduate qualifications

(1.5%)

(1.4%)

(1.8%)

Other

(1.8%)

(1.4%)

(2.2%)

Not known

(0.8%)

(0.9%)

(0.4%)

Current net fortnightly income

Less than $300 per fortnight

(3.2%)

(3.8%)

(2.0%)

X²= 2.618, df= 4, p = 0.624

Between $300 - $499 per fortnight

209

(11.5%)

(7.5%)

(9.2%)

Between $500 - $799 per fortnight

1080

(59.2%)

139

(65.6%)

321

(63.1%)

Between $800 - $1000 per fortnight

232

(12.7%)

(13.7%)

(13.9%)

More than $1000 per fortnight

139

(7.6%)

(4.2%)

(3.5%)

Not known

107

(5.9%)

(5.2%)

(8.3%)

Participation in paid employment

Employed in any job in last 12 months

596

(32.7%)

(21.7%)

134

(26.3%)

X²= 1.860, df= 2, p = 0.395

Home duties/ caring/ retired/ volunteer/ unpaid/ student

258

(14.1%)

(14.2%)

(14.3%)

No formal activity (includes unemployed)

971

(53.2%)

136

(64.2%)

302

(59.3%)

DIP ICD-10 diagnosis

Schizophrenia

857

(47.0%)

111

(52.4%)

236

(46.4%)

X²=14.824, df= 6, *p = 0.022

Schizoaffective

293

(16.1%)

(15.6%)

(14.5%)

Bipolar, mania

319

(17.5%)

(14.6%)

(14.9%)

Depressive psychosis

(4.4%)

(2.4%)

(5.1%)

Delusional disorders and other non-organic psychosis

(5.0%)

(8.0%)

(4.5%)

Severe depression disorder

158

(8.7%)

(6.6%)

(11.8%)

Screen-positive for psychosis but did not meet full criteria for ICD-10 psychosis

(1.4%)

(0.5%)

(2.8%)

Participation in any community rehabilitation or day therapy program (last 12 months)

1133

(62.1%)

(0.5%)

(11.4%)

Yes

666

(36.5%)

211

(99.5%)

447

(87.8%)

Not known

(1.4%)

(0.8%)

Location of community rehabilitation or day therapy program (last 12 months)

Public

hospital

605

(33.2%)

189

(89.2%)

408

(80.2%)

Yes

(3.3%)

(9.9%)

(7.7%)

Not known

(1.5%)

(0.5%)

(0.8%)

Not applicable

1133

(62.1%)

(0.5%)

(11.4%)

Private hospital

659

(36.1%)

210 (99.1%)

441

(86.6%)

Yes

(0.3%)

(1.2%)

Not known

(1.5%)

(0.5%)

(0.8%)

Not applicable

1133

(62.1%)

(0.5%)

(11.4%)

Government funded community-based centre

460

(25.2%)

152

(71.7%)

301

(59.1%)

Yes

205

(11.2%)

(27.4%)

146

(28.7%)

Not known

(1.5%)

(0.5%)

(0.8%)

Not applicable

1133

(62.1%)

(0.5%)

(11.4%)

Non-government funded community-based centre

203

(11.1%)

(31.6%)

135 (26.5%)

Yes

464

(25.4%)

143

(67.5%)

314

(61.7%)

Not known

(1.4%)

(0.5%)

(0.4%)

Not applicable

1133

(62.1%)

(0.5%)

(11.4%)

Participation in Nutrition and Physical Activity Program

Government sector and hospitals

170

(9.3%)

Yes

(5.3%)

Not known

(1.3%)

Not applicable

1535

(84.1%)

Non-government sector

379

(20.8%)

Yes

159

(8.7%)

Not known

(1.6%)

Not applicable

1258

(68.9%)

M (SD)–mean (standard deviation); ICD–International Statistical Classification of Diseases and Related Health Problems; X²–Chi Square test; t–independent sample T test; * p < 0.05; **p < 0.01; ***p< 0.001; NA–Not applicable.

Table 1: Demographic Characteristics of Participants from the Survey of High Impact Psychosis by Attendance at a Nutrition and Physical Activity Program.

		Total Sample N = 1825 (N %) or M (SD)	Nutrition and Physical Activity Program Attendance in the Government Sector and Hospitals		Nutrition and Physical Activity Program Attendance in the Non-Government Sector		Tests of Association with Nutrition and Physical Activity Program Participation in the Government Sector and Hospitals	Tests of Association with Nutrition and Physical Activity Program Participation in the Non-Government Sector
			No n=170	Yes n=97	No n=379	Yes N=159
Meal events per day (last 4 weeks)	0-2 meal events	548 (30.0%)	48 (28.2%)	20 (20.6%)	112 (29.6%)	36 (22.6%)	X²= 2.120, df= 2, p = 0.347	X²= 2.781, df = 2, p = 0.249
	3-4 meal events	826 (45.3%)	80 (47.1%)	52 (53.6%)	157 (41.4%)	71 (44.7%)
	³ 5 meal events	437 (23.9%)	39 (22.9%)	25 (25.8%)	107 (28.2%)	51 (32.1%)
	Not known	14 (0.8%)	3 (1.8%)	-	3 (0.8%)	1 (0.6%)
Eats breakfast (days per week in last 4 weeks)	0-3 days per week	877 (48.1%)	72 (42.4%)	40 (41.2%)	180 (47.5%)	66 (41.5%)	X²= 0.088, d f= 1, p = 0.766	X²= 1.683, df = 1, p = 0.195
	³ 4 days per week	939 (51.5%)	95 (55.9%)	57 (58.8%)	198 (52.2%)	93 (58.5%)
	Not known	9 (0.5%)	3 (1.8%)	-	1 (0.3%)	-
Milk consumed (serves per day in last 4 weeks)	Does not drink milk	98 (5.4%)	6 (3.5%)	4 (4.1%)	21 (5.5%)	7 (4.4%)	X²= 0.629, df= 3, p = 0.890	X²= 11.366, df = 3, *p = 0.010
	Full cream milk	1018 (55.8%)	82 (48.2%)	43 (44.3%)	228 (60.2%)	76 (47.8%)
	Low or reduced fat or skim milk	575 (31.5%)	70 (41.2%)	45 (46.4%)	93 (24.5%)	62 (39.0%)
	Soy or evaporated or sweetened condensed or other type of milk	114 (6.2%)	9 (5.3%)	5 (5.2%)	30 (7.9%)	13 (8.2%)
	Not known	20 (1.1%)	3 (1.8%)	-	7 (1.8%)	1 (0.6%)
Vegetables consumed (serves per day in last 4 weeks)	0-1 serves	887 (48.6%)	78 (45.9%)	46 (47.4%)	189 (49.9%)	74 (46.5%)	X²= 0 .088, df= 2, p = 0.957	X²= 0.601, df = 2, p = 0.741
	2-3 serves	715 (39.2%)	68 (40.0%)	40 (41.2%)	142 (37.5%)	65 (40.9%)
	4-6 serves	206 (11.3%)	21 (12.4%)	11 (11.3%)	44 (11.6%)	19 (11.9%)
	Not known	17 (0.9%)	3 (1.8%)	-	4 (1.1%)	1 (0.6%)
Fruit consumed (serves per day in last 4 weeks)	0-1 serves	1297 (71.1%)	99 (58.2%)	63 (64.9%)	265 (69.9%)	102 (64.2%)	X²= 0.831, df= 2, p = 0.660	X²= 1.952, df = 2, p = 0.377
	2-3 serves	452 (24.8%)	62 (36.5%)	31 (32.0%)	97 (25.6%)	49 (30.8%)
	4-6 serves	59 (3.2%)	6 (3.5%)	3 (3.1%)	13 (3.4%)	7 (4.4%)
	Not known	17 (0.9%)	3 (1.8%)	-	4 (1.1%)	1 (0.6%)
Salt added to food (last 4 weeks)	Never	650 (35.6%)	62 (36.5%)	28 (28.9%)	152 (40.1%)	57 (35.8%)	X²= 3.090, df= 3, p = 0.378	X²= 4.013, df = 3, p = 0.260
	Rarely	252 (13.8%)	33 (19.4%)	19 (19.6%)	47 (12.4%)	26 (16.4%)
	Sometimes	348 (19.1%)	27 (15.9%)	23 (23.7%)	71 (18.7%)	38 (23.9%)
	Usually	560 (30.7%)	45 (26.9%)	27 (27.8%)	104 (27.4%)	37 (23.3%)
	Not known	15 (0.8%)	3 (1.8%)	-	5 (1.3%)	1 (0.6%)
Ran out of food (last 12 months)	No	1296 (71.0%)	114 (67.1%)	75 (77.3%)	258 (68.1%)	127 (79.9%)	X²= 2.474, df = 1, p = 0.116	X²= 7.232, df= 1, **p= 0.007
	Yes	519 (28.4%)	53 (31.2%)	22 (22.7%)	119 (31.4%)	32 (20.1%)
	Not known	10 (0.5%)	3 (1.8%)	-	2 (0.5%)	-
Physical activity (min/week)	Walking	214.8 (334.7)	211.3 (342.5)	167.3 (174.9)	227.1 (376.3)	220.5 (279.9)	Mean rank for No=135.55 & Yes=131.28 U= 7981, Z= -0.436 p= 0.663	Mean rank for No=264.42 & Yes=281.62 U= 28204, Z= -1.174 p= 0.240
	Moderate activity	76 (241.0)	74.2 (191.4)	51.5 (107.5)	51.3 (180.5)	42.5 (123.2)	Mean rank for No=133.97 & Yes=134.05 U= 8240, Z= -0.010 p= 0.992	Mean rank for No=266.08 & Yes=277.64 U= 28835.50, Z= -1.003 p= 0.316
	Vigorous activity	55.6 (193.8)	34.0 (110.5)	43.5 (96.8)	35.4 (127.8)	43.4 (106.5)	Mean rank for No=130.25 & Yes=140.57 U=7607.50, Z= -1.508 p= 0.131	Mean rank for No=263.92 & Yes=282.79 U= 28017, Z= -1.893 p= 0.058

M (SD)–mean (standard deviation); X²–Chi Square test; U– Mann-Whitney U test; df–degrees of freedom; * p < 0.05; **p < 0.01; ***p< 0.001

Table 2: Nutrition and Physical Activity Characteristics by Nutrition and Physical Activity Program Attendance in the Government Sector and Hospitals, and Non-Government Sector.

Government Sector and Hospitals

n = 97 (n %)

M (SD)

Non-government Sector

n = 159 (n %)

M (SD)

Duration of program in weeks

19.4

(19.6)

31.6

(21.1)

Completed program

(10.3%)

(12.6%)

Still on

(40.2%)

101

(63.5%)

Yes

(49.5%)

(18.9%)

Not known

(5.0%)

Benefit

(8.2%)

(3.8%)

Some

(39.2%)

(30.8%)

A lot

(52.6%)

(61.6%)

Not known

(3.8%)

Table 3: Characteristics of Nutrition and Physical Activity Program Attendance in the Government Sector and Hospitals, and Non-Government Sector.

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Self-Reported Nutrition and Physical Activity Program Utilisation among Australians with Psychosis: A Cross-Sectional Analysis of Data