Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 11;68(1):e53.
doi: 10.1192/j.eurpsy.2025.2442.

A network approach to lifestyle behaviors and health outcomes in people with mental illness: the MULTI+ study III

Natascha M den Bleijker  1   2 , Myrthe M E van Schothorst  1   3 , Tessa F Blanken  4   5 , Ingrid J M Hendriksen  6 , Wiepke Cahn  2   7 , Jeroen Deenik  1   2   3
Affiliations

A network approach to lifestyle behaviors and health outcomes in people with mental illness: the MULTI+ study III

Natascha M den Bleijker et al. Eur Psychiatry. .

Abstract

Background: Unhealthy lifestyle behaviors are prevalent among people with mental illness (MI), affecting their physical and mental health. Most research has focused on the isolated effects of lifestyle behaviors, leaving the interconnectedness between these behaviors and health outcomes unexplored. This study aimed to examine these relationships and identify the most strongly connected lifestyle behavior or health outcome within a network.

Methods: We conducted a cross-sectional study with 423 inpatients with MI, receiving care as usual. Lifestyle behaviors, physical and mental health outcomes were assessed through questionnaires and routine data. A Gaussian Graphical Model was estimated, and strength centrality was calculated to identify the most influential nodes.

Results: Mean age was 55.5 years, 42% were female, and 41% were diagnosed with schizophrenia. Psychological and physical quality of life (QoL), nighttime sleep problems, and overall sleep quality were the most strongly connected nodes. Sleep was strongly associated with physical QoL. Furthermore, there were negative associations between healthy food intake and cholesterol ratio, and positive associations between daily doses of antipsychotics and length of hospital stay. Node strength was stable (CS(cor = 0.7) = 0.75). No clear pattern emerged among other lifestyle behaviors and health outcomes.

Conclusions: This study offers insights into the interrelatedness of lifestyle behaviors and health outcomes. Addressing sleep problems could enhance QoL and potentially influence other health outcomes. Psychological and physical QoL were also strongly associated, emphasizing the importance of perceived well-being in health outcomes. Future research could explore causal pathways to identify treatment targets to improve care.

Keywords: lifestyle behavior; mental health; network approach; physical health; sleep.

PubMed Disclaimer

Conflict of interest statement

None of the authors have any competing interests

Figures

Figure 1.
Figure 1.
Graphical representation of the estimated network model, including lifestyle behaviors, physical health, and mental health, differentiated by colors. Blue edges indicate a positive conditional association, and red edges indicate a negative conditional association. The thickness and saturation of edges are proportional to the strength of the conditional association. Higher scores on overall sleep quality mean more overall sleep problems.
Figure 2.
Figure 2.
Centrality plot illustrating the strength of the nodes in the network depicted in Figure 1. Nodes are ordered from the node with the highest strength to the node with the lowest strength. Node strength quantifies how strongly a node is directly connected to other nodes (summing the absolute value of the edges to each node). All values are standardized, with higher values indicating more centrality.
See this image and copyright information in PMC

References

    1. Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, et al. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiat 2019;6:675–712. 10.1016/S2215-0366(19)30132-4. - DOI - PubMed
    1. Firth J, Solmi M, Wootton RE, Vancampfort D, Schuch FB, Hoare E, et al. A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiat 2020;19:360–80. 10.1002/wps.20773. - DOI - PMC - PubMed
    1. Correll CU, Solmi M, Veronese N, Bortolato B, Rosson S, Santonastaso P, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiat 2017;16:163–80. 10.1002/wps.20420. - DOI - PMC - PubMed
    1. Bendayan R, Kraljevic Z, Shaari S, Das-Munshi J, Leipold L, Chaturvedi J, et al. Mapping multimorbidity in individuals with schizophrenia and bipolar disorders: evidence from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register. BMJ Open 2022;12:e054414. 10.1136/bmjopen-2021-054414. - DOI - PMC - PubMed
    1. Plana-Ripoll O, Pedersen CB, Agerbo E, Holtz Y, Erlangsen A, Canudas-Romo V, et al. A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. Lancet 2019;394:1827–35. 10.1016/S0140-6736(19)32316-5. - DOI - PubMed