Top

BMC Psychiatry

Published in:

01-12-2021 | Schizophrenia | Research

Design and pilot evaluation of an evidence-based worksheet and clinician guide to facilitate nutrition counselling for patients with severe mental illness

Authors: Laura LaChance, Monique Aucoin, Kieran Cooley

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

Schizophrenia spectrum disorders (SSD) are severe, persistent mental illnesses resulting in considerable disability and premature mortality. Emerging evidence suggests that diet may be a modifiable risk factor in mental illness; however, use of nutritional counselling as a component of psychiatric clinical practice is limited. The objective of this project is the design and evaluate a worksheet and clinician guide for use in facilitating nutritional counseling in the context of existing mental health care.

Methods

The worksheet and clinician guide were developed based on the results of a recent scoping review on the relationship between diet and mental health symptoms among individuals with SSD. A feedback process involved a focus group with psychiatrists and interviews with individuals with lived experience with psychosis. Participants were asked a series of structured and open-ended questions. Interviews were transcribed and data units were allocated to categories from an existing framework. The comments were used to guide modifications to the worksheet and clinician guide. A brief interview with all participants was completed to gather feedback on the final version.

Results

Five psychiatrist participants and six participants with lived experience completed interviews. Participants provided positive comments related to the worksheet design, complexity and inclusion of interactive components. A novel theme emerged relating to the lack of nutritional counselling in psychiatric training and clinical practice. Many constructive comments were provided which resulted in meaningful revisions and improvements to the worksheet and clinician guide design and content. All participants were satisfied with the final versions.

Conclusions

A worksheet and clinician guide designed to facilitate nutritional counselling with individuals with SSD was found to be acceptable to all participants following a process of feedback and revision. Further research and dissemination efforts aimed at increasing the use of nutritional counselling in psychiatric practice are warranted.

Available only for authorised users

Gatov E, Rosella L, Chiu M, Kurdyak PA. Trends in standardized mortality among individuals with schizophrenia, 1993-2012: a population-based, repeated cross-sectional study. CMAJ. 2017;189(37):E1177–E87. https://doi.org/10.1503/cmaj.161351.CrossRefPubMedPubMedCentral

Agarwal SM, Caravaggio F, Costa-Dookhan KA, Castellani L, Kowalchuk C, Asgariroozbehani R, et al. Brain insulin action in schizophrenia: something borrowed and something new. Neuropharmacology. 2019;163:107633. https://doi.org/10.1016/j.neuropharm.2019.05.010.CrossRefPubMed

Pillinger T, McCutcheon RA, Vano L, Mizuno Y, Arumuham A, Hindley G, et al. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis. Lancet Psychiatry. 2020;7(1):64–77. https://doi.org/10.1016/S2215-0366(19)30416-X.CrossRefPubMedPubMedCentral

Correll CU, Robinson DG, Schooler NR, Brunette MF, Mueser KT, Rosenheck RA, et al. Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: baseline results from the RAISE-ETP study. JAMA Psychiatry. 2014;71(12):1350–63. https://doi.org/10.1001/jamapsychiatry.2014.1314.CrossRefPubMed

Stubbs B, Williams J, Gaughran F, Craig T. How sedentary are people with psychosis? A systematic review and meta-analysis. Schizophr Res. 2016;171(1–3):103–9. https://doi.org/10.1016/j.schres.2016.01.034.CrossRefPubMed

Teasdale SB, Ward PB, Samaras K, Firth J, Stubbs B, Tripodi E, et al. Dietary intake of people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. 2019;214(5):251–9. https://doi.org/10.1192/bjp.2019.20.CrossRefPubMed

Myles N, Newall HD, Curtis J, Nielssen O, Shiers D, Large M. Tobacco use before, at, and after first-episode psychosis: a systematic meta-analysis. J Clin Psychiatry. 2012;73(4):468–75. https://doi.org/10.4088/JCP.11r07222.CrossRefPubMed

Galderisi S, De Hert M, Del Prato S, Fagiolini A, Gorwood P, Leucht S, et al. Identification and management of cardiometabolic risk in subjects with schizophrenia spectrum disorders: a Delphi expert consensus study. Eur Psychiatry. 2021;64(1):e7. https://doi.org/10.1192/j.eurpsy.2020.115.CrossRefPubMedPubMedCentral

Sarris J, Logan AC, Akbaraly TN, Amminger GP, Balanza-Martinez V, Freeman MP, et al. Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry. 2015;2(3):271–4. https://doi.org/10.1016/S2215-0366(14)00051-0.CrossRefPubMed

10.

Molendijk M, Molero P, Ortuno Sanchez-Pedreno F, Van der Does W, Martinez-Gonzalez MA. Diet quality and depression risk: a systematic review and dose-response meta-analysis of prospective studies. J Affect Disord. 2018;226:346–54. https://doi.org/10.1016/j.jad.2017.09.022.CrossRefPubMed

11.

Dipasquale S, Pariante CM, Dazzan P, Aguglia E, McGuire P, Mondelli V. The dietary pattern of patients with schizophrenia: a systematic review. J Psychiatr Res. 2013;47(2):197–207. https://doi.org/10.1016/j.jpsychires.2012.10.005.CrossRefPubMed

12.

Jacka FN, O'Neil A, Opie R, Itsiopoulos C, Cotton S, Mohebbi M, et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med. 2017;15(1):23. https://doi.org/10.1186/s12916-017-0791-y.CrossRefPubMedPubMedCentral

13.

Aucoin M, LaChance L, Cooley K, Kidd S. Diet and psychosis: a scoping review. Neuropsychobiology. 2018;79(1):1–23. https://doi.org/10.1159/000493399.CrossRef

14.

Eaton CB, Goodwin MA, Stange KC. Direct observation of nutrition counseling in community family practice. Am J Prev Med. 2002;23(3):174–9. https://doi.org/10.1016/S0749-3797(02)00494-4.CrossRefPubMed

15.

De Hert M, Detraux J, van Winkel R, Yu W, Correll CU. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nat Rev Endocrinol. 2011;8(2):114–26. https://doi.org/10.1038/nrendo.2011.156.CrossRefPubMed

16.

McMorris T, Sweet G Jr, Sullivan CJ, Washington NB, Brahm N. A design and focus group evaluation of dietary choices tools for an underserved population. Ment Health Clin. 2016;6(2):101–8. https://doi.org/10.9740/mhc.2016.03.101.CrossRefPubMedPubMedCentral

17.

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;74(10):e177–232. https://doi.org/10.1016/j.jacc.2019.03.010.CrossRefPubMedPubMedCentral

18.

Sarris J. Nutritional psychiatry: from concept to the clinic. Drugs. 2019;79(9):929–34. https://doi.org/10.1007/s40265-019-01134-9.CrossRefPubMed

19.

Teasdale SB, Morkl S, Muller-Stierlin A. Nutritional psychiatry in the treatment of psychotic disorders: Current hypotheses and research challenges. Brain Behav Immun Health. 2020;5:100070.CrossRefPubMedPubMedCentral

20.

Baute V, Sampath-Kumar R, Nelson S, Basil B. Nutrition education for the health-care provider improves patient outcomes. Glob Adv Health Med. 2018;7:2164956118795995. https://doi.org/10.1177/2164956118795995.CrossRefPubMedPubMedCentral

21.

Morkl S, Stell L, Buhai DV, Schweinzer M, Wagner-Skacel J, Vajda C, et al. ‘An Apple a Day’?: Psychiatrists, Psychologists and Psychotherapists Report Poor Literacy for Nutritional Medicine: International Survey Spanning 52 Countries. Nutrients. 2021;13(3):822.CrossRefPubMedPubMedCentral

22.

Giguere A, Zomahoun HTV, Carmichael PH, Uwizeye CB, Legare F, Grimshaw JM, et al. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2020;8(8):CD004398. https://doi.org/10.1002/14651858.CD004398.pub4.CrossRefPubMed

23.

Government of Canada. Eating well with Canada’s food guide 2019. [Available from: https://foodguide.canada.ca/en/. Accessed 8 Nov 2021.

24.

Fishbein M, Yzer MC. Using theory to design effective health behavior interventions. Commun Theory. 2003;13(2):164–83. https://doi.org/10.1111/j.1468-2885.2003.tb00287.x.CrossRef

25.

El-Mallakh P. Doing my best: poverty and self-care among individuals with schizophrenia and diabetes mellitus. Arch Psychiatr Nurs. 2007;21(1):49–60. https://doi.org/10.1016/j.apnu.2006.10.004.CrossRefPubMed

26.

Hand RK, Medrow L, Brown K. Developing and assessing nutrition education handouts (DANEH): testing the validity and reliability of the new tool. J Acad Nutr Diet. 2015;115(5):816–23. https://doi.org/10.1016/j.jand.2015.01.010.CrossRefPubMed

27.

Papadaki A, Scott JA. Process evaluation of an innovative healthy eating website promoting the Mediterranean diet. Health Educ Res. 2006;21(2):206–18. https://doi.org/10.1093/her/cyh057.CrossRefPubMed

28.

Teasdale SB, Ward PB, Rosenbaum S, Watkins A, Curtis J, Kalucy M, et al. A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with first-episode psychosis. Br J Nutr. 2016;115(11):1987–93. https://doi.org/10.1017/S0007114516001033.CrossRefPubMed

29.

Bonfioli E, Berti L, Goss C, Muraro F, Burti L. Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials. BMC Psychiatry. 2012;12(1):78. https://doi.org/10.1186/1471-244X-12-78.CrossRefPubMedPubMedCentral

30.

Teasdale SB, Samaras K, Wade T, Jarman R, Ward PB. A review of the nutritional challenges experienced by people living with severe mental illness: a role for dietitians in addressing physical health gaps. J Hum Nutr Diet. 2017;30(5):545–53. https://doi.org/10.1111/jhn.12473.CrossRefPubMed

31.

Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60. https://doi.org/10.1177/1049732315617444.CrossRefPubMed

32.

Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3(6):514–22. https://doi.org/10.1370/afm.405.CrossRefPubMedPubMedCentral

33.

Lenz M, Kasper J, Muhlhauser I. Development of a patient decision aid for prevention of myocardial infarction in type 2 diabetes - rationale, design and pilot testing. Psycho-Soc-Med. 2009;6:Doc05.

34.

Chiu M, Amartey A, Wang X, Kurdyak P. Ethnic differences in mental health status and service utilization: a population-based study in Ontario. Canada Can J Psychiatry. 2018;63(7):481–91. https://doi.org/10.1177/0706743717741061.CrossRefPubMed

35.

Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;2:CD003030. https://doi.org/10.1002/14651858.CD003030.pub2.CrossRef

36.

Wenger E, McDermott RA, Snyder W. Cultivating communities of practice. Brighton: Harvard Business School Press; 2002.

37.

Rolls K, Hansen M, Jackson D, Elliott D. How health care professionals use social media to create virtual communities: an integrative review. J Med Internet Res. 2016;18(6):e166. https://doi.org/10.2196/jmir.5312.CrossRefPubMedPubMedCentral

38.

Flodgren G, O'Brien MA, Parmelli E, Grimshaw JM. Local opinion leaders: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2019;6(6):CD000125. https://doi.org/10.1002/14651858.CD000125.pub5.CrossRefPubMed

39.

Marriott S, Palmer C, Lelliott P. Disseminating healthcare information: getting the message across. Qual Health Care. 2000;9(1):58–62. https://doi.org/10.1136/qhc.9.1.58.CrossRefPubMedPubMedCentral

40.

Townsend J, Roderick P, Cooper J. Cigarette smoking by socioeconomic group, sex, and age: effects of price, income, and health publicity. BMJ. 1994;309(6959):923–7. https://doi.org/10.1136/bmj.309.6959.923.CrossRefPubMedPubMedCentral

41.

A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. JAMA. 2000;283(24):3244–54.

42.

Devries S, Freeman AM. Nutrition education for cardiologists: the time has come. Curr Cardiol Rep. 2017;19(9):77. https://doi.org/10.1007/s11886-017-0890-6.CrossRefPubMed

43.

Harvey JAH, Neild PJ. Nutritional training in gastroenterology. Frontline Gastroenterol. 2010;1(1):19–24. https://doi.org/10.1136/fg.2009.000232.CrossRefPubMedPubMedCentral

Title: Design and pilot evaluation of an evidence-based worksheet and clinician guide to facilitate nutrition counselling for patients with severe mental illness
Authors: Laura LaChance
Monique Aucoin
Kieran Cooley
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Schizophrenia
Nutrition
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03575-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Design and pilot evaluation of an evidence-based worksheet and clinician guide to facilitate nutrition counselling for patients with severe mental illness

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Depressive symptoms associated with COVID-19 preventive practice measures, daily activities in home quarantine and suicidal behaviors: Findings from a large-scale online survey in Bangladesh

Using deep learning to classify pediatric posttraumatic stress disorder at the individual level

Characteristics and outcomes of children with dissociative (conversion) disorders in western China: a retrospective study

A national survey on depressive and anxiety disorders in Afghanistan: A highly traumatized population

Prolonged apnea after ECT in organophosphorus poisoning – the need to redefine norms

The first experimental study of transference work–in teenagers (FEST–IT): a multicentre, observer- and patient-blind, randomised controlled component study