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DOI: 10.1055/s-0034-1375634
Ungesunder Lebensstil bei Patienten einer psychosomatischen Poliklinik und Konsilambulanz
Unhealthy Lifestyle in Patients of a Psychosomatic Outpatient and Consultation-Liaison ClinicPublication History
eingereicht 17 November 2013
akzeptiert 12 April 2014
Publication Date:
16 July 2014 (online)
Zusammenfassung
Patienten mit psychischen Störungen haben ein höheres Risiko für die Entwicklung körperlicher Erkrankungen. Als wesentlicher Risikofaktor hierfür gilt ein ungesunder Lebensstil. Um präventive Ansatzpunkte zu finden, untersuchten wir, wie häufig ein ungesunder Lebensstil bei psychosomatischen Patienten vorkommt und wie dieser mit psychischen und somatischen Beschwerden zusammenhängt. Hierzu wurde die klinische Basisdokumentation der Jahre 2009–2011 von n=1 919 ambulanten psychosomatischen Patienten ausgewertet. Körperliche Inaktivität war mit 62,4% das häufigste Lebensstilrisiko, gefolgt vom Rauchen (33,2%) und Adipositas (17,4%). Alle Lebensstilrisiken waren mit einer höheren Symptombelastung und funktionalen Beeinträchtigung assoziiert. Raucher hatten mehr stationäre psychiatrische oder psychosomatische Vorbehandlungen. Die Ergebnisse sprechen dafür, den Lebensstil bei Patienten mit seelischen Erkrankungen stärker bei der Behandlung zu berücksichtigen.
Abstract
Patients with mental disorders have an increased risk for somatic diseases. Especially life style risk factors contribute to this increased risk. In order to identify targets for preventive measures, we aimed to determine the prevalence of an unhealthy lifestyle in a clinical sample and to analyze associations with severity of mental disorders and somatic complaints. We analyzed the medical records of n=1 919 outpatients, who were treated between 2009–2011 in the Department of Psychosomatic Medicine and Psychotherapy of the University Medical Center Mainz. 62.4% of the patients were physically inactive, 33.2% were smokers and 17.4% were obese. Lifestyle risk factors were associated with increased symptom burden and impairment. Smoking was strongly associated with more previous psychiatric or psychosomatic inpatient treatments. These results indicate an urgent need for targeting health behavior more rigorously in the treatment of patients with common mental disorders.
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Literatur
- 1 Moussavi S, Chatterji S, Verdes E et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370: 851-858
- 2 Kuper H, Nicholson A, Kivimaki M et al. Evaluating the causal relevance of diverse risk markers: horizontal systematic review. BMJ 2009; 339: b4265
- 3 Shah AJ, Veledar E, Hong Y et al. Depression and history of attempted suicide as risk factors for heart disease mortality in young individuals. Archives of General Psychiatry 2011; 68: 1135
- 4 Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 2013; 346: f2539
- 5 Whooley MA. de Jonge P, Vittinghoff E et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 2008; 300: 2379-2388
- 6 Khaled SM, Bulloch AG, Williams JV et al. Persistent heavy smoking as risk factor for major depression (MD) incidence – Evidence from a longitudinal Canadian cohort of the National Population Health Survey. J Psychiatr Res 2012; 46: 436-443
- 7 Ye SQ, Muntner P, Shimbo D et al. Behavioral Mechanisms, Elevated Depressive Symptoms, and the Risk for Myocardial Infarction or Death in Individuals With Coronary Heart Disease The REGARDS (Reason for Geographic and Racial Differences in Stroke) Study. J Am Coll Cardiol 2013; 61: 622-630
- 8 Gubata ME, Urban N, Cowan DN et al. A prospective study of physical fitness, obesity, and the subsequent risk of mental disorders among healthy young adults in army training. J Psychosom Res 2013; 75: 43-48
- 9 Uebelacker LA, Eaton CB, Weisberg R et al. Social support and physical activity as moderators of life stress in predicting baseline depression and change in depression over time in the Women’s Health Initiative. Soc Psychiatry Psychiatr Epidemiol 2013;
- 10 Byers AL, Vittinghoff E, Lui LY et al. Twenty-year depressive trajectories among older women. Arch Gen Psychiatry 2012; 69: 1073-1079
- 11 Teychenne M, Ball K, Salmon J. Sedentary behavior and depression among adults: a review. Int J Behav Med 2010; 17: 246-254
- 12 Teychenne M, Ball K, Salmon J. Physical activity and likelihood of depression in adults: a review. Prev Med 2008; 46: 397-411
- 13 Rimer J, Dwan K, Lawlor DA et al. Exercise for depression. Cochrane Database Syst Rev 2012; 7 CD004366
- 14 Michal M, Wiltink J, Reiner I et al. Association of mental distress with smoking status in the community: Results from the Gutenberg Health Study. Journal of affective disorders 2013; 146: 355-360
- 15 Lasser K, Boyd JW, Woolhandler S et al. Smoking and mental illness: A population-based prevalence study. JAMA 2000; 284: 2606-2610
- 16 Colman I, Naicker K, Zeng Y et al. Predictors of long-term prognosis of depression. CMAJ 2011; 183: 1969-1976
- 17 Boden JM, Fergusson DM, Horwood LJ. Cigarette smoking and depression: tests of causal linkages using a longitudinal birth cohort. Br J Psychiatry 2010; 196: 440-446
- 18 McDermott MS, Marteau TM, Hollands GJ et al. Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study. The British journal of psychiatry: the journal of mental science 2013; 202: 62-67
- 19 Jamal M, Willem Van der Does AJ, Cuijpers P et al. Association of smoking and nicotine dependence with severity and course of symptoms in patients with depressive or anxiety disorder. Drug Alcohol Depend 2012; 126: 138-146
- 20 Jamal M, Does AJ, Penninx BW et al. Age at smoking onset and the onset of depression and anxiety disorders. Nicotine Tob Res 2011; 13: 809-819
- 21 Busch M, Hapke U, Mensink GBM. Psychische Gesundheit und gesunde Lebensweise. Hrsg Robert Koch-Institut; Berlin: 2011. GBE kompakt 2 (7)
- 22 WHO. Dilling H, Mombour W, Schmidt MH Hrsg. Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F). Diagnostische Kriterien für Forschung und Praxis; 4. Aufl. Bern: Huber: 2006.
- 23 Kroenke K, Spitzer RL, Williams JB et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 2010; 32: 345-359
- 24 Löwe B, Kroenke K, Herzog W et al. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). Journal of Affective Disorders 2004; 81: 61-66
- 25 Löwe B, Decker O, Müller S et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care 2008; 46: 266-274
- 26 Lowe B, Spitzer RL, Williams JB et al. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry 2008; 30: 191-199
- 27 Spitzer RL, Gibbon M, Williams JB et al. Global assessment of functioning (GAF) scale. Outcomes assessment in clinical practice 1996; 76-78
- 28 Leon AC, Olfson M, Portera L et al. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med 1997; 27: 93-105
- 29 Pulos L. Childhood Adversity and Adult Health. In: Tacoma Pierce County Health Department 2012
- 30 Schulz K-H, Meyer A, Langguth N. Körperliche Aktivität und psychische Gesundheit. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz 2012; 55: 55-65
- 31 Kilian R, Becker T, Kruger K et al. Health behavior in psychiatric in-patients compared with a German general population sample. Acta Psychiatr Scand 2006; 114: 242-248
- 32 DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW Hrsg für die Leitliniengruppe Unipolare Depression. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression-Kurzfassung. 1. Auflage 2009 DGPPN, ÄZQ, AWMF; Berlin, Düsseldorf: 2009
- 33 Teo K, Lear S, Islam S et al. Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study. JAMA: the journal of the American Medical Association 2013; 309: 1613-1621
- 34 Schroeder SA. Shattuck Lecture. We can do better – improving the health of the American people. N Engl J Med 2007; 357: 1221-1228
- 35 Chwastiak L, Cruza-Guet MC, Carroll-Scott A et al. Preventive Counseling for Chronic Disease: Missed Opportunities in a Community Mental Health Center. Psychosomatics 2012;
- 36 Prochaska JJ, Hall SE, Delucchi K et al. Efficacy of Initiating Tobacco Dependence Treatment in Inpatient Psychiatry: A Randomized Controlled Trial. Am J Public Health 2013;
- 37 Schroeder SA. Depression, smoking, and heart disease: how can psychiatrists be effective?. Am J Psychiatry 2011; 168: 876-878
- 38 Schroeder SA. A 51-year-old woman with bipolar disorder who wants to quit smoking. JAMA 2009; 301: 522-531
- 39 Hall SM, Prochaska JJ. Treatment of smokers with co-occurring disorders: emphasis on integration in mental health and addiction treatment settings. Annu Rev Clin Psychol 2009; 5: 409-431
- 40 Weiser P, Becker T, Losert C et al. European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods. BMC Public Health 2009; 9: 315
- 41 Michal M, Simon P, Gori T et al. Psychodynamic Motivation and Training program (PMT) for the secondary prevention in patients with stable coronary heart disease: study protocol for a randomized controlled trial of feasibility and effects. Trials 2013; 14: 314
- 42 Wilkinson DL, Sniehotta FF, Michie S. Targeting those in need: baseline data from the first English National Health Service (NHS) health trainer service. Psychol Health Med 2011; 16: 736-748