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

Article information

Res Community Public Health Nurs. 2018;29(1):76-86
Publication date (electronic) : 2018 March 12
doi : https://doi.org/10.12799/jkachn.2018.29.1.76
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 2017 September 22; Revised 2018 January 29; Accepted 2018 January 29.

Abstract

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.

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

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

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

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

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Article information Continued

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 (%) n (%) n (%)
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
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 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
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)
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
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.