title: Contextual Factors in the Health of People With Serious Mental Illness.
abstract: People living with serious mental illness (SMI) have shorter life expectancies than the general population. We examined how contextual factors influence the physical health of this population. We conducted interviews, focus groups, and participant observations with stakeholders from six behavioral health organizations. We found that consumers' avoidance of overt disagreement during medical visits, their mistrust of medical institutions, and cultural variations in body image influenced the clinical encounter. Mental health providers' ambivalence about intervening in consumers' physical health, primary care providers' misattribution of physical symptoms to mental disorders, and providers' stigmatization of consumers shaped clinical encounters. Consumers' diets were shaped by food environments and social norms associated with traditional diets. Internal and external factors impacted consumers' physical activity. In this article, we illustrate the importance of considering contextual factors in the development and implementation of interventions aimed at improving the physical health of people with SMI.
authors: Columbia University, New York, New York, USA ljc2139@columbia.edu.
authors: Leopoldo J
authors: LJ
authors: Cabassa
authors: University of Southern California, Los Angeles, California, USA.
authors: Elizabeth
authors: E
authors: Siantz
authors: New York State Psychiatric Institute, New York, New York, USA.
authors: Andel
authors: A
authors: Nicasio
authors: Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA.
authors: Peter
authors: P
authors: Guarnaccia
authors: Columbia University, New York, New York, USA.
authors: Roberto
authors: R
authors: Lewis-Fernández
keywords: culture / cultural competence; health and well-being; mental health and illness; research, qualitative