The impact of poor diet quality and nutritional inadequacies on mental health and mental illness has recently gained considerable attention in science. As the opinions and experiences of people living with serious mental illness on dietary issues are unknown, we aimed to understand the role of nutrition in a biopsychosocial approach. In total, 28 semi-structured interviews were conducted with people living with serious mental illness (SMI) in Australia, Germany and Austria, and a generic thematic analysis approach was applied. Four positive (positive effects on the body and mind, therapeutic effects in treating somatic illnesses, pleasure and opportunity for self-efficacy) and three negative (impairment related to mental illness and its treatment, perceived stigma and negative effects on the body and mind) implications of diet were identified. A key issue for most of the participants was the mental burden arising from their body weight. This might indicate that negative implications, such as guilt and stigma, were of primary importance for people with SMI when talking about their dietary behavior. In conclusion, diet-related support is urgently needed for people with SMI. However, especially participants from Germany and Austria reported that this is not yet widely available in mental health settings, leading to hopelessness and resignation.

Disordered eating behaviors are common in people with a serious mental illness (SMI) such as schizophrenia, bipolar disorder and major depressive disorder. This study employed qualitative exploration to understand the perceived determinants of eating behaviors, in particular those connected to disordered eating patterns, in people with SMI. In total, 28 semi-structured interviews were conducted in a consecutive sample of people with SMI under treatment in local mental health services in Australia (n = 12), Germany (n = 8) and Austria (n = 8) (mean age: 43.3 years, proportion of female participants: 61%, proportion of participants with ICD-10 F2 diagnosis: 57%, proportion of participants with ICD-10 F3 diagnosis: 64%). A thematic analysis approach, the framework method, was applied using MAXQDA 2020. Three main themes of determinants were derived: (i) impacts to daily functioning, (ii) disrupted physical hunger cues and (iii) emotional hunger. For impacts to daily functioning, the following themes emerged: lack of daily structure, time and drive, and difficulty planning ahead. For physical hunger, themes emerged for disrupted hunger and satiety cues, and mindless eating. All motives listed in the Palatable Eating Motives Scale (PEMS), i.e., coping, reward, social and conformity, have been reported by participants to be drivers for their emotional eating behavior. Subsequent reported behaviors were eating too much or too little, binge eating, night eating and food cravings. We conclude that interprofessional approaches should target daily functioning, disrupted physical hunger cues and emotional eating to reduce disordered eating behaviors in people with SMI.

Zusammenfassung Ziel der Studie In dieser Studie untersuchten wir die subjektiven Erfahrungen und Wünsche von Betroffenen in Bezug auf ernährungs- und gewichtsbezogene Unterstützung im Rahmen der Regelversorgung. Methodik Insgesamt wurden 16 Interviews mit Erwachsenen mit einer schweren psychischen Erkrankung anhand eines semi-strukturierten Leitfadens in Ulm (Deutschland) und Graz (Österreich) durchgeführt und qualitativ ausgewertet. Ergebnisse Einige Betroffenen kritisierten die aus ihrer Sicht unzureichende Unterstützung durch Fachkräfte bei ernährungs- und gewichtsbezogenen Problemen und wünschen sich eine stärkere Adressierung dieser Themen in der psychiatrischen Versorgung. Schlussfolgerung Die Implementierung von gesundheitsfördernden Angeboten in der psychiatrischen Versorgung ist wichtig, um eine aus Betroffenensicht bedürfnisorientierte Versorgung zu schaffen. Durch interdisziplinäre Versorgungskonzepte könnten Verantwortlichkeiten diesbezüglich auf mehrere Berufsgruppen verteilt werden.