Mental health informed physical activity for first responders and their support partner: a protocol for a stepped-wedge evaluation of an online, codesigned intervention
Grace McKeon, Zachary Steel, Ruth Wells, Jill M Newby, Dusan Hadzi-Pavlovic, Davy Vancampfort, Simon Rosenbaum, Grace McKeon, Zachary Steel, Ruth Wells, Jill M Newby, Dusan Hadzi-Pavlovic, Davy Vancampfort, Simon Rosenbaum
Abstract
Background: First responders (police, fire and ambulance officers) are at a significantly increased risk of experiencing poor mental health, including depression and post-traumatic stress disorder. These conditions are associated with high rates of cardiovascular disease, in part due to low levels of physical activity (PA) and high levels of sedentary behaviour. Using a person's social support system may be an effective solution to help increase PA levels to improve mental and physical health outcomes. We will examine the efficacy of a group-based online intervention in increasing PA in first responders and their support partners, iteratively codesigned with advisors with lived experience of mental illness among first responders.
Methods: This study will recruit a convenience sample of self-identified sedentary first responders and their self-selected support partners to a 10-week PA programme delivered through a private Facebook group. We will deliver education on predetermined topics related to PA and diet and provide participants with an activity tracker (Fitbit). A stepped-wedged design will be applied to compare multiple baselines to intervention and follow-up phases within subjects. Five cohorts of n=20 will be recruited, with each cohort randomised to a different baseline length. Our primary outcome will be psychological distress (Kessler-6). Secondary outcomes include feasibility, self-report and objective PA data (Simple Physical Activity Questionnaire and Fitbit accelerometry), depression and anxiety (Depression Anxiety and Stress Scale-21 items), post-traumatic stress disorder symptoms (PTSD Checklist for DSM-5), quality of life Assessment of Quality of Life-6 dimensions, sleep quality (The Pittsburgh Sleep Quality Index), suicidal ideation (Suicidal Ideation Attributes Scale) and social support for exercise. The mobile data collection platform MetricWire will be used.
Ethics and dissemination: Ethical approval was obtained from the University of New South Wales, Deupty Vice-Chancellor Research, Human Research Ethics Committee on 3 June 2019, HC180561. Findings will be published in peer-reviewed journals and disseminated at national conferences.
Trial registration number: ACTRN12619000877189.
Keywords: PTSD; emergency service workers; facebook; first responder; mental health; physical activity.
Conflict of interest statement
Competing interests: None declared.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Figures
References
- Harvey SB, Milligan-Saville JS, Paterson HM, et al. . The mental health of fire-fighters: an examination of the impact of repeated trauma exposure. Aust N Z J Psychiatry 2016;50:649–58. 10.1177/0004867415615217
- Harvey S, Devilly G, Forbes D, et al. . Expert guidelines: diagnosis and treatment of post-traumatic stress disorder in emergency service workers 2015.
- Fullerton CS, Ursano RJ, Wang L. Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J Psychiatry 2004;161:1370–6. 10.1176/appi.ajp.161.8.1370
- Berger W, Coutinho ESF, Figueira I, et al. . Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Soc Psychiatry Psychiatr Epidemiol 2012;47:1001–11. 10.1007/s00127-011-0408-2
- Creamer M, Burgess P, McFarlane AC. Post-Traumatic stress disorder: findings from the Australian national survey of mental health and well-being. Psychol Med 2001;31:1237–47. 10.1017/S0033291701004287
- Smith TC, Ryan MAK, Wingard DL, et al. . New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. BMJ 2008;336:366–71. 10.1136/
- Paul Barratt LS, Palmer M. When helping hurts: PTSD in First-responders: Australia21; 2018.
- McLaughlin KA, Koenen KC, Friedman MJ, et al. . Subthreshold posttraumatic stress disorder in the world Health organization world mental health surveys. Biol Psychiatry 2015;77:375–84. 10.1016/j.biopsych.2014.03.028
- Momartin S, Silove D, Manicavasagar V, et al. . Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia. J Affect Disord 2004;80:231–8. 10.1016/S0165-0327(03)00131-9
- Schnurr PP, Lunney CA, Sengupta A, et al. . A longitudinal study of retirement in older male veterans. J Consult Clin Psychol 2005;73:561–6. 10.1037/0022-006X.73.3.561
- Jakupcak M, Cook J, Imel Z, et al. . Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan war veterans. J Trauma Stress 2009;22:303–6. 10.1002/jts.20423
- Roberts AL, Agnew-Blais JC, Spiegelman D, et al. . Posttraumatic stress disorder and incidence of type 2 diabetes mellitus in a sample of women: a 22-year longitudinal study. JAMA Psychiatry 2015;72:203–10. 10.1001/jamapsychiatry.2014.2632
- Bartoli F, Crocamo C, Alamia A, et al. . Posttraumatic stress disorder and risk of obesity: systematic review and meta-analysis. J Clin Psychiatry 2015;76:e1253–61. 10.4088/JCP.14r09199
- Rosenbaum S, Stubbs B, Ward PB, et al. . The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis. Metabolism 2015;64:926–33. 10.1016/j.metabol.2015.04.009
- Boscarino JA. Posttraumatic stress disorder and physical illness: results from clinical and epidemiologic studies. Ann N Y Acad Sci 2004;1032:141–53. 10.1196/annals.1314.011
- Vancampfort D, Richards J, Stubbs B, et al. . Physical activity in people with PTSD: a systematic review of correlates. J Phys Act Health 2016;13:910–8.
- Vancampfort D, Knapen J, Probst M, et al. . A systematic review of correlates of physical activity in patients with schizophrenia. Acta Psychiatr Scand 2012;125:352–62. 10.1111/j.1600-0447.2011.01814.x
- de Assis MA, de Mello MF, Scorza FA, et al. . Evaluation of physical activity habits in patients with posttraumatic stress disorder. Clinics 2008;63:473–8. 10.1590/S1807-59322008000400010
- Stubbs B, Vancampfort D, Hallgren M, et al. . EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and position statement from the European psychiatric association (EPA), supported by the International organization of physical therapists in mental health (IOPTMH). Eur Psychiatry 2018;54:124–44. 10.1016/j.eurpsy.2018.07.004
- Rosenbaum S, Vancampfort D, Steel Z, et al. . Physical activity in the treatment of post-traumatic stress disorder: a systematic review and meta-analysis. Psychiatry Res 2015;230:130–6. 10.1016/j.psychres.2015.10.017
- Rosenbaum S, Tiedemann A, Sherrington C, et al. . Physical activity interventions for people with mental illness: a systematic review and meta-analysis. J Clin Psychiatry 2014;75:964–74. 10.4088/JCP.13r08765
- Haugen PT, McCrillis AM, Smid GE, et al. . Mental health stigma and barriers to mental health care for first responders: a systematic review and meta-analysis. J Psychiatr Res 2017;94:218–29. 10.1016/j.jpsychires.2017.08.001
- Schuch FB, Vancampfort D, Firth J, et al. . Physical activity and incident depression: a meta-analysis of prospective cohort studies. Am J Psychiatry 2018;175:631–48. 10.1176/appi.ajp.2018.17111194
- Brown RA, Prince MA, Minami H, et al. . An exploratory analysis of changes in mood, anxiety and craving from pre- to post-single sessions of exercise, over 12 weeks, among patients with alcohol dependence. Ment Health Phys Act 2016;11:1–6. 10.1016/j.mhpa.2016.04.002
- Rosenbaum S, Sherrington C, Tiedemann A. Exercise augmentation compared with usual care for post-traumatic stress disorder: a randomized controlled trial. Acta Psychiatr Scand 2015;131:350–9. 10.1111/acps.12371
- Harvey SB, Øverland S, Hatch SL, et al. . Exercise and the prevention of depression: results of the HUNT cohort study. Am J Psychiatry 2018;175:28–36. 10.1176/appi.ajp.2017.16111223
- Cavallo DN, Tate DF, Ries AV, et al. . A social media-based physical activity intervention: a randomized controlled trial. Am J Prev Med 2012;43:527–32. 10.1016/j.amepre.2012.07.019
- Naslund JA, Aschbrenner KA, Marsch LA, et al. . Facebook for supporting a lifestyle intervention for people with major depressive disorder, bipolar disorder, and schizophrenia: an exploratory study. Psychiatr Q 2018;89:81–94. 10.1007/s11126-017-9512-0
- Moran J, Kelly G, Haberlin C, et al. . The use of eHealth to promote physical activity in patients with mental health conditions: a systematic review. HRB Open Res 2018;1 10.12688/hrbopenres.12796.1
- Wheeler AJ, Roennfeldt H, Slattery M, et al. . Codesigned recommendations for increasing engagement in structured physical activity for people with serious mental health problems in Australia. Health Soc Care Community 2018;26:860–70. 10.1111/hsc.12597
- Soundy A, Freeman P, Stubbs B, et al. . The value of social support to encourage people with schizophrenia to engage in physical activity: an international insight from specialist mental health physiotherapists. J Ment Health 2014;23:256–60. 10.3109/09638237.2014.951481
- Schuch FB, Dunn AL, Kanitz AC, et al. . Moderators of response in exercise treatment for depression: a systematic review. J Affect Disord 2016;195:40–9. 10.1016/j.jad.2016.01.014
- Norton KCJ, Parker R, Williams A, et al. . New Australian standard for adult pre-exercise screening. Sport Health 2012;30:12–18.
- Kessler RC, Andrews G, Colpe LJ, et al. . Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002;32:959–76. 10.1017/S0033291702006074
- Naslund JA, Aschbrenner KA, Marsch LA, et al. . Feasibility and acceptability of Facebook for health promotion among people with serious mental illness. Digit Health 2016;2. doi:10.1177/2055207616654822
- Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101. 10.1191/1478088706qp063oa
- Greenwood JLJ, Joy EA, Stanford JB. The physical activity vital sign: a primary care tool to guide counseling for obesity. J Phys Act Health 2010;7:571–6. 10.1123/jpah.7.5.571
- Rosenbaum S, Ward PB, International Working Group . The simple physical activity questionnaire. Lancet Psychiatry 2016;3:e1 10.1016/S2215-0366(15)00496-4
- Henry JD, Crawford JR. The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 2005;44:227–39. 10.1348/014466505X29657
- Blevins CA, Weathers FW, Davis MT, et al. . The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress 2015;28:489–98. 10.1002/jts.22059
- Buysse DJ, Reynolds CF, Monk TH, et al. . The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213. 10.1016/0165-1781(89)90047-4
- Richardson JRJ, Peacock SJ, Hawthorne G, et al. . Construction of the descriptive system for the assessment of quality of life AQoL-6D utility instrument. Health Qual Life Outcomes 2012;10:38 10.1186/1477-7525-10-38
- Sallis JF, Grossman RM, Pinski RB, et al. . The development of scales to measure social support for diet and exercise behaviors. Prev Med 1987;16:825–36. 10.1016/0091-7435(87)90022-3
- van Spijker BAJ, Batterham PJ, Calear AL, et al. . The suicidal ideation attributes scale (SIDAS): community-based validation study of a new scale for the measurement of suicidal ideation. Suicide Life Threat Behav 2014;44:408–19. 10.1111/sltb.12084
- Firth J, Torous J, Yung AR. Ecological momentary assessment and beyond: the rising interest in e-mental health research. J Psychiatr Res 2016;80:3–4. 10.1016/j.jpsychires.2016.05.002
- Matthews E, Cowman M, Denieffe S. Using experience-based co-design for the development of physical activity provision in rehabilitation and recovery mental health care. J Psychiatr Ment Health Nurs 2017;24:545–52. 10.1111/jpm.12401
- Firth J, Rosenbaum S, Stubbs B, et al. . Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis. Psychol Med 2016;46:2869–81. 10.1017/S0033291716001732
- Aschbrenner KA, Mueser KT, Naslund JA, et al. . Facilitating partner support for lifestyle change among adults with serious mental illness: a feasibility pilot study. Community Ment Health J 2017;53:394–404. 10.1007/s10597-017-0100-4
- Bailey JM, Wye PM, Wiggers JH, et al. . Family carers: a role in addressing chronic disease risk behaviours for people with a mental illness? Prev Med Rep 2017;7:140–6. 10.1016/j.pmedr.2017.05.014
- Albert R, Simpson A. Double deprivation: a phenomenological study into the experience of being a carer during a mental health crisis. J Adv Nurs 2015;71:2753–62. 10.1111/jan.12742
- ROWE J. Great expectations: a systematic review of the literature on the role of family carers in severe mental illness, and their relationships and engagement with professionals. J Psychiatr Ment Health Nurs 2012;19:70–82. 10.1111/j.1365-2850.2011.01756.x
- Gutiérrez-Maldonado J, Caqueo-Urízar A, Kavanagh DJ. Burden of care and general health in families of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2005;40:899–904. 10.1007/s00127-005-0963-5
- Savage S, Bailey S. The impact of caring on caregivers' mental health: a review of the literature. Aust Health Rev 2004;27:111–7. 10.1071/AH042710111
- Happell B, Wilson K, Platania-Phung C, et al. . Physical health and mental illness: listening to the voice of carers. J Ment Health 2017;26:127–33. 10.3109/09638237.2016.1167854
- Mick Palmer BW. A First Responders’ Perspective. Trauma – related stress in Australia. Essays by leading Australian thinkers and researchers 2016:38–43.
- Barwick M. Knowledge translation planning template. Ontario: The Hospital for Sick Children, 2013.
Source: PubMed