Study design and participants
A cross-sectional survey was conducted in NHS Community Mental Health Team (CMHT)s in England. CMHT is an umbrella term used to describe a multi-professional team involved in the delivery of mental health care and it’s formed of community psychiatric nurses, occupational therapists, social workers, psychologists, psychiatrists, and health care support workers.
From June 2017 to May 2018, participants were recruited in six participating NHS Trusts covering a range of geographical areas, in both urban and rural contexts: Cornwall Partnership NHS Foundation Trust; Devon Partnership NHS Trust; East London NHS Foundation Trust (covering East London, Luton and Bedfordshire); Oxford Health NHS Foundation Trust (covering large areas of Oxfordshire and Buckinghamshire), and Somerset Partnership NHS Foundation Trust; Tees, Esk and Wear Valleys NHS Foundation Trust (covering county Durham, Darlington, Teeside, York and North Yorkshire). Participants were identified by clinicians or clinical study officers from CMHTs caseloads.
Participants were eligible for inclusion if they met the following criteria:
• Adults aged 18-65 years old
• A clinical diagnosis of a psychotic disorder according to the International Classification of Disease-10 (ICD-10) codes F20-29, as identified in clinical records
• Receiving care from outpatient secondary mental health services or primary care services
• Have capacity to provide informed consent
• Able to communicate in English
Exclusion criteria:
• A current and primary diagnosis of substance use disorder (ICD-10 F10-19)
• Had been hospitalised in the previous week (although these potential participants could be re-approached at a later time)
• Their postcodes could not be obtained because they were homeless or living in temporary accommodation at the time of the survey.
Procedures and measures
Eligible participants were identified by clinicians or clinical study officers and asked for their agreement to speak to one member of the research team. Participants then completed the study questionnaires and researchers accessed participant clinical records to retrieve clinical and socio-demographic characteristics. All participants who agreed to take part in this study were interviewed in quiet rooms in community mental health teams, primary care settings, or at participant’s homes using standardised case report forms. All interviews were face-to-face and took about 45 minutes to complete. Several measures were used during the assessments:
First, the Time Use Survey (TUS) (19) explored whether participants engaged in leisure activities in the past week and for more than 10 minutes in each activity. It included activities such as going out for a meal, going to the cinema, museum, library, day centre, going to the gym, outdoor trips or attending a religious group/activity. We also collected data on whether participants attended sports activities in the last 7 days.
Second, participants reported satisfaction with quality and quantity of friendships, financial situation and accommodation measured using the sixteen items of the Manchester Short Assessment of Quality of Life (MANSA), which was rated on a score from 1 (very dissatisfied) to 7 (very satisfied). For example, researchers asked questions such as: How satisfied are you with: your life as a whole today; being unemployed; financial situation; your friendships; your leisure activities; your accommodation; your personal safety; people that you live with; your sex life; your physical health and your mental health.
MANSA has been widely used to assess the quality of life of people with psychosis and its psychometric properties have been well established (20-22).
Researchers collected additional participant characteristics such as age, gender (male/female), marital status (single/in a relationship), country of birth (born in the United Kingdom/born in a different country), education level (primary/secondary/further), living situation (living alone/living with someone), accommodation (living independently/living in supported accommodation), employment (employed/not employed), receipt of welfare benefits (or not), and length of illness (calculated in number of years from the day of first contact with mental health services). These were collected from participants assessments and checked against available data in medical records.
Description of the Sample
A sample of 548 participants completed the study, of whom 535 (97.6%) reported their participation in leisure activities during the previous week. 407 (74.3%) participants responded to all 16 questions related to the quality of life MANSA measure. The number of people who responded to MANSA questions was different from one question to another; for example: 527 responded to “how satisfied they were with their life as a whole”; 521 to “financial situation”; 429 to “sex life”, 523 to “mental health”. Due to missing data and given that many explanatory variables were used in the multivariate model, the number of respondents decreased from 535 to 396.
Ethics Committee Approval
The West Midlands – Solihull Research Ethics Committee (17/WM/0191) approved the study, protocol, and informed consent forms. All participants were given the information sheet about the survey and written informed consent was obtained from all participants.
Statistical analysis
Descriptive statistics (i.e., Mean and Standard Deviation) are reported for quality of life, leisure activities, sport activities and social contacts. We report the mean, standard error, and 95% confidence interval of quality of life of participants when they (a) did not attend any leisure activities, (b) attended at least one leisure activity.
Linear regression analysis tested associations between quality of life and attendance in leisure activities. First, we used univariable tests to explore the associations between individual participant-level variables and the dependent variable. Second, each significant association at an alpha level of 10% in these univariable tests was entered in a final multivariable model, set at a significance level of 5%. In the regression analysis, quality of life was set as the outcome variable and attendance in leisure activities as independent variables. We controlled for socio-demographic factors and for sports activities as participants were asked (alongside leisure activities) to report their participation in fitness activities during the previous week.
We reported odds ratios (OR) with their corresponding 95% confidence intervals (CI). All statistical analyses were conducted using Stata 16.0 software (23).