Study shows how people with severe and persistent mental illnesses live their everyday lives

A study by two Indiana University Bloomington professors in the School of Health, Physical Education and Recreation is beginning to suggest how people with severe and persistent mental illnesses live their everyday lives.

SPMI is a condition in which disorders such as bipolar disorder and, particularly, schizophrenia affect daily living. Building upon studies suggesting that people with SPMI fare better in developing countries than in the United States, associate professors Bryan McCormick, in the Department of Recreation and Park Administration, and Georgia Frey, in the Department of Kinesiology, recruited study participants from community mental health programs in both the American Midwest and Serbia.

McCormick and Frey asked study participants to wear motion sensors to record physical activity continuously for seven consecutive days. During the same seven days, participants also wore watches programmed to signal seven times daily at random intervals. At the signal, participants were to note in a booklet what they were doing, who they were with, their mood and other aspects of daily activity. This unique pairing of research tools provided data that were more reliable than surveys which rely on a person's recall.

Among the findings:

• The study participants were surprisingly inactive. Inactivity is important to note, Frey said, because physical activity is considered a major health indicator for chronic diseases. During waking hours of the study, the participants wore uniaxial accelerometers, which measured activity levels. The intensity was recorded in "counts per minute." Frey compared the findings to a sedentary population, people who have mental retardation and people who exercise regularly. The study participants' activity level averaged approximately 305 counts per minute, compared to 312 counts per minutes averaged by the sedentary comparison group, 330 counts per minute averaged by the comparison group with mental retardation, and 550 counts per minute averaged by the active comparison group.

• The study participants were alone less often than expected. Compared to the general population in the United States, the study participants were alone less often then older adults and about as often as working adults. Social contacts are important, in part, because studies have shown isolation has a negative impact on a person's health, McCormick said. The study participants lived in the Midwest and Serbia, in large towns located in rural areas approximately two hours from metropolitan areas. The social contacts of the study participants reflected the conventional family structure in the two countries. Participants in Serbia, where extended families are the norm, spent more time with family members and spouses. The U.S. participants spent more time with friends, who also were likely to be psychiatric patients. As a result, the Serbian participants were likely to have access to more support, McCormick said.

• Participants from both countries reported that most of their daily activities were easy. The Serbian participants reported slightly more challenge in their everyday activities. McCormick said he wants to explore whether some people actively seek to avoid challenging activity, since it has been found to be associated with feelings of anxiety, a particularly problematic mood for people with SPMI.

Mental health systems in Serbia, as well as in most Balkan states, are considered "developing" because they have been crippled by a lack of money since the collapse of the former Yugoslavia. Many people living in mental health institutions in Serbia, for example, would be receiving treatment from community mental health services in the United States.

McCormick and Frey are working to move beyond the current focus on diagnosis and control of the symptoms, and assumptions about how people with SPMI live their lives. They want to reach a better understanding of the overall health and quality of life of people with such conditions to determine if scientists can devise interventions to improve their lives.

The next phases of this research involve filling in more of the overall health picture by looking at health indicators such as body mass index, examining connections between mood and activity, creating interventions, and then measuring to see if they actually improve the quality of life of people with SPMI.

The research has received funding from the IU Multidisciplinary Ventures Fund, the IU Dean of Faculties, the IU Department of Recreation and Park Administration, the IU Department of Kinesiology, the Russian and East European Institute's Mellon Endowment Research Grant-in-Aid, and the IU President's Council on International Programs.

Sanghee Chun, a doctoral student in the Department of Recreation and Park Administration, and Chien-Tsung Lee, a doctoral student in the Department of Kinesiology, helped conduct the study. The research team's colleagues in Serbia include Dr. Tomislav Gajic, head of psychiatry, Health Center Valjevo; Dr. Branka Gajic, psychiatrist, Health Center Valjevo; and Dr. Milena Maksimovic, psychologist, Health Center Valjevo.