A Multidomain Lifestyle Intervention for Psychiatric Outpatients (CHAPTER): a Pilot RCT

Introduction: Lifestyle-related health issues are common in people with mental illness, contributing to a decreased life expectancy of 15-20 years compared to the general population and high societal and personal burden. Effects of multidomain lifestyle interventions on the overall recovery of psychiatric patients are understudied. This study aimed to investigate the feasibility, acceptability, and preliminary effectiveness on recovery of a multidomain lifestyle intervention in patients with severe or chronic mental illnesses.

Methods: A transdiagnostic group (n=20) of outpatients was 1:1 randomised to the intervention or control condition. The intervention consisted of 11 three-hour group sessions about physical activity, nutrition, relaxation, sleep, substance use, social support and purpose and meaning. Self-report questionnaires, physical measurements, diary questions, accelerometers and semi-structured interviews were administered at baseline, halfway and post intervention. Feasibility and acceptance outcomes included attrition, retention rates, protocol deviations, and quantitative and qualitative evaluations. Multiple recovery and lifestyle behaviour outcomes were assessed.

Results: Diagnoses of participants (mean treatment duration: 15 years) included severe and/or chronic mood, personality, anxiety, somatic symptom and ADHD. Both the intervention and research protocol appeared feasible and acceptable, with relaxation, purpose and meaning and nutrition as highest appreciated themes. Intervention attendance was low (all sessions: 1/10) and drop-out high (3/10). However, overall experiences with the intervention were positive, also among drop-outs. Intervention simplification and deepening was necessary to suit the needs of this heterogeneous group. Preliminary effects were found on all recovery domains, with biggest effects in societal recovery and smallest effects in clinical recovery. Effects on lifestyle behaviour were not unambiguous.

Discussion-conclusion: Based on our positive preliminary findings, multidomain lifestyle interventions for psychiatric outpatients might be a promising innovative intervention. However, to reduce drop-out and match the heterogeneous outpatient population, a more flexible intervention protocol is recommended. A replication study with a greater sample size is needed.