Melbourne School of Psychological Sciences - Theses
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ItemThe CARE project: improving physical health outcomes for young people with first episode psychosis( 2016)People with psychotic disorders have 2-3 times the risk of dying early compared to the general population. This is primarily due to modifiable risk factors for cardiovascular disease, including increased smoking, poor diet and low physical activity contributing to overweight and obesity. Previous non-pharmacological physical health interventions have largely been atheoretical and have typically only included people with chronic schizophrenia. Although these interventions have generally resulted in weight loss, it is usually not clinically significant and there is a lack of evidence suggesting outcomes persist beyond the end of intervention. There is also limited evidence that non-pharmacological interventions for smoking cessation are successful in the chronic schizophrenia population. Physical health deterioration occurs in the first years following initial treatment with antipsychotic medication. It is therefore likely that intervening early in the course of a psychotic illness to prevent weight gain and promote early smoking cessation attempts will be more effective than interventions for weight loss and smoking cessation at later stages of illness. The present thesis sought to overcome challenges related to treatment effects by adopting Self-Determination Theory (SDT) to frame the development and evaluation of a physical health intervention development, and its subsequent analysis, allowing for clearer targeting of mechanisms of action. SDT emphasises autonomy, competence and relatedness as being core psychological needs that energise intrinsic motivation for health behaviour. Study One examined mental health clinicians’ motivation towards physical health intervention with a mixed methods design. Clinicians described a lack of perceived autonomy and competence as barriers to addressing physical health concerns of consumers with first episode psychosis (FEP). Study Two examined the feasibility and acceptability of the Competence, Autonomy, Relatedness and Experiential (CARE) intervention using a single group repeated measures design for 16 participants with FEP. The intervention was associated with improved symptoms and quality of life, and seven of nine the participants who completed the intervention did not experience significant weight gain at two-month follow-up. Participants also reported increased perceived autonomy support for physical health change, but no difference in intrinsic motivation and competence for physical health change. While participants described the CARE intervention as acceptable, accessibility contributed to low attendance and completion rate. Study Three examined the perspectives of participants in Study Two in relation to physical health intervention preferences. Participants reported the need for accessible interventions that are easy to follow and involve active participation. SDT provided a useful framework for understanding both clinician motivation for physical health intervention, and participants’ experience of the CARE intervention and challenges engaging in behaviour change.
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ItemPhysical exercise activity in individuals with schizophrenia( 2005)Sedentary lifestyle, a common problem in individuals with schizophrenia, presents a risk factor for cardiovascular disease and other physical and mental health problems. While attempts have been made to implement exercise interventions in this group, controlled experimental designs are lacking. Furthermore, no study of the determinants of physical exercise in this population has been reported. Therefore, this thesis was designed to investigate the applicability of the transtheoretical model (Di Clemente & Prochaska, 1982), incorporating stages of change, self-efficacy, processes (cognitive and behavioural), and decisional balance, to the prediction of exercise in individuals with schizophrenia. In addition, the role of clinical symptomatology (positive and negative psychotic symptoms and depression) and physical health, both in determining exercise activity and in moderating the transtheoretical model predictors, was examined. Finally, the potential relationship between exercise stage and each of: demographic characteristics, other health risk behaviours, side effects of medication and other psychiatric illness-related characteristics, was explored. Forty-nine individuals diagnosed with schizophrenia and receiving treatment in the community participated in this study. The key measures, all administered in the form of an interview, included the Exercise Stages of Change Measure, the Exercise Self-Efficacy Scale, the Exercise Processes of Change Scale, the Exercise Decisional Balance Measure, the Positive and Negative Syndrome Scale and the Centre for Epidemiological Studies Depression Scale. The physical health variables included Self-Rated Health, blood pressure and body mass index. Overall, there was support for the applicability of the transtheoretical model to exercise behaviour in individuals with schizophrenia. Additionally, increased severity of negative psychotic symptoms and depression and poorer (self-rated) physical health were predictive of lower stages of exercise, with self-rated health having a significant independent contribution. As expected, the transtheoretical model mediating constructs improved the variance in exercise stage explained by clinical symptoms and self-rated health, respectively, though this did not reach statistical significance. As predicted, self-rated health significantly improved the variance in exercise stage explained by the transtheoretical model mediators, with self-rated health making a significant unique contribution to the prediction of exercise stage. However, contrary to expectations, clinical symptomatology did not reliably improve the prediction of exercise stage made by the transtheoretical model mediators. Contrary to expectations, clinical symptomatology and self-rated health did not moderate the relationship between the transtheoretical model mediators and exercise stage. Finally, apart from the health risk behaviour of caffeine consumption, inconsistent with predictions, a relationship between exercise stage and each of demographic characteristics, health risk behaviours, side effects of medication and other psychiatric illness-rated characteristics, was not found. These findings represent a preliminary attempt to understand the determinants of naturally occurring exercise behaviour in a sample of individuals with schizophrenia, which to date, has been largely overlooked in research. It is concluded that while the transtheoretical model may be efficacious in explaining exercise in behaviour in individuals with schizophrenia, the role of self-rated health and the symptoms of schizophrenia in this area of research cannot be underestimated. The implications of these findings for the design of targeted interventions and routine mental health care provision are discussed.