Using Digital Technologies for Health Promotion in Young People with Mental Illness

患有精神障碍(如精神分裂症)的人在身体健康方面经历了很大的不平等；这越来越被认为是一个人权问题。特别是，心脏代谢合并症的发生率极高，因为精神障碍与肥胖、糖尿病和心血管疾病的风险是普通人群的2-3倍。这些身体上的合并症在很大程度上解释了在这一人群中观察到的预期寿命差距~20年，这正在扩大加班。这种糟糕的身体健康可归因于抗精神病药物(具有严重的新陈代谢副作用)和一系列不利的健康行为或“生活方式风险因素”的组合，包括缺乏锻炼、不良饮食和高吸烟率。重要的是，我之前的研究表明，这些生活方式风险因素从一开始就被观察到(称为首发精神病，FEP)。当与抗精神病药物治疗结合在一起时，这些风险因素导致年轻人的身体健康迅速恶化--这反过来又进一步阻碍他们的福祉和康复，同时增加疾病的个人、社会和经济负担。尽管如此，最近的初步研究(由我和其他人领导)表明，为患有FEP的年轻人提供生活方式干预可以降低心脏代谢风险，并改善身体和心理健康结果。不幸的是，个性化生活方式干预的资源密集型性质可能会阻碍这些方法的临床转化和可扩展性。因此，需要新的方法来制定可持续和可扩展的干预措施，以保护接受FEP治疗的年轻人的代谢健康。NHS的五年展望呼吁更充分地利用数字技术来解决医疗保健领域悬而未决的问题。此外，减少身体健康的不平等和改善早期干预都是《心理健康五年目标》中的关键优先事项。此外，我们即将到来的柳叶刀精神病学委员会(我作为主席和第一作者领导该委员会)发现，移动健康(MHealth)可能为保护患有精神疾病的年轻人的代谢健康提供新的机会，因为mHealth干预措施在这一群体中具有很高的可及性和可接受性。然而，到目前为止，这方面的研究还很少。因此，我将利用这一奖学金来研究如何利用数字技术来保护FEP患者的身体健康，方法是在疾病的早期阶段针对健康行为。这将涉及一个由三个工作包(包括观测和实验研究)组成的战略计划，以产生“第一个实地”发现，同时也为大规模实施研究和新技术开发提供信息。首先，我将与主要利益攸关方(包括患者、照顾者和临床医生)进行定性和定量研究，以深入了解健康应用程序在青少年心理健康方面的最佳特性/功能。在此之后，我将进行一系列实验研究，经验性地测试NHS认可的现有mHealth生活方式干预在患有精神疾病的年轻人中的可用性和有效性。在这方面，我还将探讨采用更健康的生活方式(由移动健康技术促进)对改善患有FEP的年轻人的身体健康结果和心理健康的潜在好处。在完成这些新颖研究的同时，我还将与数字心理健康干预领域的世界领先者合作，为FEP开发定制的生活方式干预措施，并评估其在现有护理系统中的实施情况。总的来说，这项工作将提供对数字生活方式干预措施的可接受性、有效性和实施情况的基本见解，以保护患有精神疾病的年轻人的身体健康和改善结果。

People with psychotic disorders (such as schizophrenia) experience large inequalities in physical health; which is increasingly recognised as a human rights issue. In particular, there is a highly elevated incidence of cardiometabolic comorbidities, as psychotic disorders are associated with 2-3 fold risk of obesity, diabetes and cardiovascular disease compared to the general population. These physical comorbidities account for much of the ~20 year gap in life expectancy observed in this population, which is widening overtime. This poor physical health is attributable to a combination of antipsychotic medications (which have severe metabolic side-effects) and a range of adverse health behaviours, or 'lifestyle risk factors', including lack of exercise, poor diet, and high rates of smoking. Importantly, my previous research has shown these lifestyle risk factors are observed from very onset of illness (termed 'first episode psychosis', FEP). When combined with antipsychotic treatment, these risk factors cause the physical health of young people to deteriorate rapidly - which, in turn, further impedes their well-being and recovery while increasing the personal, social and economic burden of illness. Nonetheless, recent pilot studies (led by myself and others) have demonstrated that providing lifestyle interventions to young people with FEP can reduce cardiometabolic risk, and improve both physical and mental health outcomes. Unfortunately, the resource-intensive nature of individualised lifestyle interventions can impede the clinical translation and scalability of these approaches. Thus, new approaches are required to produce sustainable and scalable interventions for protecting metabolic health in young people treated for FEP. The NHS Five Year Forward view calls for fuller use of digital technologies to tackle unresolved issues in healthcare. Furthermore, reducing physical health inequalities and improving early intervention are both key priorities within the 'Five Year Ambitions for Mental Health' put. Alongside this, our upcoming Lancet Psychiatry Commission (which I led as Chair and first author) identified that mobile health (mHealth) may present novel opportunities for protecting metabolic health in young people with mental illness, given the high accessibility and acceptability of mHealth interventions in this group. To date however, there is a dearth of research in this area. Therefore, I will use this fellowship to examine how digital technologies can be used to protect the physical health of people with FEP, by targeting health behaviours in the early stages of illness. This will involve a strategic program of three work packages (including observational and experimental research), to produce 'first-in-field' findings, while also informing large-scale implementation studies and new technology development. First, I will conduct qualitative and quantitative studies with key stakeholders (including patients, carers and clinicians) to gain insights into optimal features/functionalities of health apps in youth mental health. Following this, I will conduct a range of experimental studies, empirically testing the usability and effectiveness of existing NHS-endorsed mHealth lifestyle interventions in young people with mental illness. Within this, I will also explore the potential benefits of adopting healthier lifestyles (as facilitated by mHealth technologies) for improving physical health outcomes and psychological well-being among young people with FEP. While completing these novel studies, I will also work with world-leaders in digital mental health interventions to develop bespoke lifestyle interventions for FEP, and evaluate their implementation with existing care systems. Collectively, this work will provide fundamental insights into the acceptability, efficacy and implementation of digital lifestyle interventions for protecting physical health and improving outcomes in young people with mental illness.