Factors associated with low fruit and vegetable consumption among people with severe mental ill health

Social Psychiatry and Psychiatric Epidemiology https://doi.org/10.1007/s00127-023-02514-z BRIEF REPORT Factors associated with low fruit and vegetable consumption among people with severe mental ill health Ben Lorimer1 · Gemma Traviss‑Turner2 · Andrew Hill2 · Sarah Baker3,4 · Simon Gilbody1,5 · Emily Peckham1 Received: 24 May 2023 / Accepted: 6 June 2023 © The Author(s) 2023 Abstract Severe mental ill health (SMI) is associated with excess mortality, and poor diet is one associated modifiable risk factor. This study investigated factors associated with low consumption of fruit and vegetables among people with SMI (N = 9914). A total of 8.4% of participants ate no portions per day, while only 15% ate 5 + portions. Individuals who never consumed fruit and vegetables or ate < 5 portions per day were more likely to be male, younger than 65, unemployed, experience poorer general health, or perceive health as unimportant. Poor diet is common among people with SMI and tailored dietary improvement interventions are required. Keywords Schizophrenia · Psychosis · Bipolar affective disorders · Severe mental ill health · Health risk behaviours · Poor diet Introduction People with severe mental ill health (SMI) have an estimated life expectancy that is 8–15 years shorter than people in the general population [1, 2]. Furthermore, this mortality gap appears to be gradually increasing over time [3]. Preventable physical diseases (e.g., cardiovascular disease) and modifiable risk factors have been demonstrated to contribute significantly to this health inequality, with one such factor being poor diet [4, 5]. For example, a 2014 survey of 1286 adults with psychosis estimated that 74% ate less than four servings of fruit and vegetables daily, and that poor diet was frequently accompanied by other unhealthy behaviours (e.g., smoking) [6]. More recently, the Closing the Gap (CtG) Health Study, which surveyed 9914 adults with schizophrenia-spectrum disorders or bipolar disorder, * Ben Lorimer 1 Department of Health Sciences, University of York, York, UK 2 School of Medicine, University of Leeds, Leeds, UK 3 York St John University, York, UK 4 York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK 5 Hull York Medical School, York, UK estimated that 85% ate less than five portions of fruits and vegetables daily [7]. Both statistics indicate that people with SMI are frequently not meeting current guidelines for fruit and vegetable consumption (i.e., at least five portions daily) [8], and that they meet such guidelines to a lesser extent than the general population (15% compared to 28%) [9]. This limited consumption may contribute to the physical health inequalities discussed previously, especially considering that fruit and vegetable consumption has been demonstrated to provide substantial benefits to human health, including reduced risk of cardiovascular disease [10]. Improving our understanding of what factors are associated with poor diet among people with SMI may enable interventions to be developed and tailored for this group. The study objectives were therefore to utilise data collected in The CtG Health Study to investigate factors associated with: (1) never eating fruit and vegetables; and (2) low consumption of fruit and vegetables (vs meeting current guidelines). Method This study extends previous descriptive analyses of data gathered from The CtG Health Study, a cross-sectional survey study conducted between April 2016 and March 2020 that examined overall health and prevalence of health risk behaviours among people with SMI. Full details of the 13 Vol.:(0123456789) Social Psychiatry and Psychiatric Epidemiology study have been reported elsewhere [7]. To summarise, adults (18 +) with a documented diagnosis of schizophrenia, bipolar disorder, or associated disorder (corresponding to ICD-10 [F20–29 or F30–31] or DSM-IV [295.x, 296.x, or 297.x] criteria) were invited to complete a self-report questionnaire. Participants were recruited from 314 primary care sites and 23 secondary care sites across England. A total of N = 9,914 participants completed the questionnaire, with n = 3,084 being recruited from primary care and n = 6,830 from secondary care. The mean age of the sample was 48.2 (SD = 14.8), with 55.4% being male, 85.2% being of white ethnicity, and 68.4% being overweight or having obesity. Table 1 describes the demographic and health information of the sample. All study procedures were approved by West Midlands Research Ethics Committee (ref: 15/WM/0444), and all participants provided written consent. Table 1  Demographic and health information of the Sample (N = 9914) Variable Socio-demographic information Gender, n (%) Male Female Transgender Age, M (SD) Ethnicity, n (%) White Black Mixed South Asian Other Asian Other Employment, n (%) In paid employment Not in paid employment Index of multiple deprivation, M (SD) Health information Body mass index, M (SD) Body mass index category, n (%) Underweight Healthy weight Overweight Having obesity Importance of maintaining a healthy lifestyle, n (%) A top priority Moderately important Not worried about it N (%a) / M (SD) 5388 (55.4) 4289 (44.1) 57 (0.01) 48.2 (14.8) 8350 (85.2) 434 (4.4) 333 (3.4) 426 (4.3) 96 (1.0) 159 (1.6) 1687 (17.4) 8006 (82.6) 4.7 (2.8) 28.9 (6.9) 184 (2.1) 2544 (29.5) 2660 (30.9) 3226 (37.5) Missing N 180b 203 116 Results 221 2493 1300 1300 78 4475 (45.5) 3839 (39.0) 1522 (15.5) a Percentages calculated using only those cases with full data (i.e., excluding missing) b Total includes participants who responded “Prefer Not to Say” 13 The questionnaire included questions related to demographics, general health, and engagement in various health risk behaviours (Supplementary Materials A). One investigated behaviour was the consumption of fruit and vegetables, with this being assessed through the following question: “In general, how many portions of fruit and vegetables do you eat per day?”. Response options included ‘I don’t eat fruit and vegetables’, ‘one’, ‘two’, ‘three’, ‘four’, and ‘five or more’. Participants were also asked to rate their overall general health in the last year (‘excellent’, ‘good’, ‘moderate’, ‘poor’, or ‘very poor’), and how important maintaining a healthy lifestyle was to them (‘a top priority’, ‘moderately important’, or ‘I don’t worry about it’). Two binary logistic regression models were conducted using a Bonferroni-adjusted alpha value of 0.025 (0.05/2). For one model, the dependent variable was eating 0 vs ≥ 1 fruit and vegetables per day, while for the second model, the dependent variable was eating ≥ 5 vs < 5 fruit and vegetables per day. The eight independent variables input into both models included: age, gender, neighbourhood deprivation (assessed by linking postcodes to the English Index of Multiple Deprivation [IMD] [11]), Body Mass Index (BMI), ethnicity, employment status, general health rating, and perceived importance of hea (...truncated)