Graduation Date

Summer 8-14-2015

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Mary Cramer

Second Advisor

Julia Houfek

Third Advisor

Shinobu Watanabe-Galloway

Abstract

Background: People with schizophrenia and bipolar disorder die significantly earlier than members of the general public (16-18 years and 12-13 years, respectively). Diseases associated with obesity such as diabetes, heart disease, and stroke account for much of this discrepancy. People with mental illness often have difficulty losing weight despite intensive interventions. As a result, nurses caring for patients with mental illness need to monitor their weight diligently and implement individualized interventions to promote achieving or maintaining a healthy weight. Because intensive interventions come with some risk and expense, programs must target individuals with the most potential to develop obesity. In the general public, a history of adverse events in childhood such as abuse are associated with elevated body mass index (BMI). Objective: The purpose of this study is to examine if a history of adverse events in childhood is associated with BMI among people with schizophrenia or bipolar disorder. Methods: A secondary analysis of the Collaborative Psychiatric Epidemiology Surveys. BMI was calculated using self-reported height and weight. A history of a number of self-reported adverse events in childhood was used to form comparison groups. These relationships were examined both among people with schizophrenia (n=181) or bipolar disorder (n=299) and respondents with no psychiatric disorders (n=5,161). Results: Among subjects without mental illness, only a history of physical abuse by someone other than a parent was significantly associated with elevated BMI. Among individuals with schizophrenia or bipolar disorder, a history of physical abuse by a parent and emotional neglect from the subject's father were associated a higher BMI. In particular, among females the odds-risk (OR) for obesity associated with physical abuse from parents was 3.34 while the OR associated with paternal emotional neglect was 2.44. Within both groups, no adverse events were significant related to BMI among males. Two types of adverse events were significantly linked with BMI in the psychiatric disorders group and one was significant in the control group. Discussion: This study indicates that practitioners should pay especially close attention to weight management among their female patients with a history of adverse events in childhood.

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