Association of Psychiatric Illness and Obesity, Physical Inactivity, and Smoking among a National Sample of Veterans

Department of Health Policy and Management, Boston University, Boston, Massachusetts, United States
Psychosomatics (Impact Factor: 1.86). 05/2011; 52(3):230-6. DOI: 10.1016/j.psym.2010.12.009
Source: PubMed


Increased cardiovascular morbidity and mortality have been reported across a number of chronic psychiatric illnesses. Interventions to decrease cardiovascular risk have focused on single health behaviors.
To evaluate the co-occurrence of multiple poor health behaviors that increase cardiovascular risk among veterans with psychiatric diagnoses.
Using data from the 1999 Large Health Survey of Veterans (n=501,161), multivariate logistic regression was used to evaluate the associations between current smoking, no regular exercise, and obesity with each of six Axis I diagnoses.
There were statistically increased odds of co-occurrence of obesity, current tobacco use, and no regular exercise among veterans with each of the psychiatric diagnoses, with the exception of drug use disorders (which was not significantly different from 1). The highest odds were among veterans with schizophrenia, PTSD, and bipolar disorder [OR (95% CI) of 1.37 (1.29, 1.45); 1.26 (1.20, 1.32); and 1.19 (1.11, 1.25), respectively]. The OR for depression was not significant after adjustment for medical comorbidity.
Veterans with psychiatric illnesses, and particularly those with schizophrenia, PTSD, and bipolar disorder, are much more likely to have multiple poor health behaviors that increase their cardiovascular risk. Interventions to decrease cardiovascular risk among veterans with serious mental illness need to target multiple health behaviors.

Download full-text


Available from: Lydia Chwastiak, Jul 25, 2014
  • Source
    • "Given the complex contributors to physical activity, comprehensive interventions to improve physical activity and related chronic diseases can maximize effectiveness by including complementary strategies at these multiple levels (Sallis et al., 2008). Evidence from observational studies of Veterans suggests that demographic characteristics, health status, psychiatric conditions, somatic symptoms, fatigue, and use of VA care are associated with lower physical activity (Bouldin and Reiber, 2012; Chasens et al., 2009; Chwastiak et al., 2011; Hoerster et al., 2012a; Littman et al., 2009). These prior studies of Veterans have focused on identifying important clinical correlates, but have not identified contextual factors that influence physical activity, which may differ from those in non-Veterans. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Veterans, especially those using U.S. Department of Veterans Affairs (VA) healthcare, have poorer health than the general population. In addition, Veterans using VA services are more likely than non-VA users to be physically inactive. Little is known about physical activity correlates among Veterans. To identify targets for health promotion interventions, understanding barriers to and facilitators of physical activity in this population is critical. This study examined individual-, social-, and perceived neighborhood-level associations of meeting weekly physical activity recommendations (150 min/week of combined leisure and transportation activity) based on the International Physical Activity Questionnaire (IPAQ) among N = 717 patients from VA Puget Sound, Seattle Division using a mailed survey sent 2012-2013 (response rate = 40%). Independent associations were identified with direct estimation of relative risks using generalized linear models (dichotomous outcome), and linear regression (continuous outcome), including variables associated in bivariate tests (p < .05). Most participants were male, Caucasian, and unemployed, and had an annual income ≤$40,000. Over two-thirds (69.9%) reported meeting physical activity recommendations. Fewer days of limitations due to physical or mental health (Relative Risk (RR) = 0.99 per day; 95% Confidence Interval (CI) = 0.98, 0.99; p = .01), others doing physical activity with the Veteran (RR = 1.18; 95% CI = 1.04, 1.33; p = .01), receiving ideas from others regarding physical activity (RR = 1.14; 95% CI = 1.01, 1.29; p = .03) and better perceived neighborhood aesthetics (RR = 1.14; 95% CI = 1.06, 1.24; p = .001) were associated with meeting physical activity recommendations. Findings were comparable for total weekly physical activity, but lower depression symptom severity was also associated with increased physical activity. This study identified individual and contextual correlates of physical activity among VA-using Veterans. Targeting these factors will be important in promoting physical activity in order to address the disproportionate disease burden facing U.S. Veterans. Existing VA interventions targeting physical activity may need to be adapted to account for the influence of contextual factors. Published by Elsevier Ltd.
    Full-text · Article · Aug 2015 · Social Science [?] Medicine
    • "behaviors , such as lack of physical activity , unhealthy diet , and smoking , are highly frequent among people suffering from PTSD ( Chwastiak et al. 2011 ; Hirth et al . 2011).Therefore,peoplewithPTSDmay haveanincreasedprevalenceofmetabolicsyndrome.Theobjectiveofthischapteristoanalyzeavailable scientificliteratureontheassociationbetweenmetabolicsyndrome–anditssubcomponents–andPTSD. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous reports highlighted that traumatic stress exposure may have a key role on both mental and physical health. People suffering from post-traumatic stress disorder (PTSD) may have a shorter life expectancy than general population, mainly due to a higher risk of cardiovascular diseases. Several factors may explain this association, but, in recent years, there has been a growing concern on the relationship between metabolic syndrome and PTSD. According to previous reports on both community and special populations’ samples, e.g., war veterans, PTSD is associated with a higher risk of suffering from metabolic syndrome as well as obesity, diabetes, hypertension, and dyslipidemia. Clinicians and mental health professionals should regularly assess and screen metabolic alterations among people with PTSD. The potential role of factors and mediators that might explain the nature of the co-occurrence of PTSD and metabolic syndrome – as well as specific interventions addressed to prevent and treat this comorbid condition – need further research.
    No preview · Chapter · Jun 2015
  • Source
    • "Results from the BRFSS indicate that the age-adjusted prevalence of current smoking was 27.0% among veterans, but the prevalence was even higher among younger veterans, between 36% and 40%, whereas the prevalence of smoking among younger nonveterans was between 22% and 30% [2]. Veterans with mental health diagnoses are also more likely to smoke [146] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Lifestyle and health-related factors are critical components of the risk for cognitive aging among veterans. Because dementia has a prolonged prodromal phase, understanding effects across the life course could help focus the timing and duration of prevention targets. This perspective may be especially relevant for veterans and health behaviors. Military service may promote development and maintenance of healthy lifestyle behaviors, but the period directly after active duty has ended could be an important transition stage and opportunity to address some important risk factors. Targeting multiple pathways in one intervention may maximize efficiency and benefits for veterans. A recent review of modifiable risk factors for Alzheimer's disease estimated that a 25% reduction of a combination of seven modifiable risk factors including diabetes, hypertension, obesity, depression, physical inactivity, smoking, and education/cognitive inactivity could prevent up to 3 million cases worldwide and 492,000 cases in the United States. Lifestyle interventions to address cardiovascular health in veterans may serve as useful models with both physical and cognitive activity components, dietary intervention, and vascular risk factor management. Although the evidence is accumulating for lifestyle and health-related risk factors as well as military risk factors, more studies are needed to characterize these factors in veterans and to examine the potential interactions between them.
    Full-text · Article · Jun 2014 · Alzheimer's and Dementia
Show more