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© 2002 American Public Health Association
RESEARCH AND PRACTICE |
Zlatka Russinova and Nancy J. Wewiorski are with the Center for Psychiatric Rehabilitation and the Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Mass. Dane Cash is with the Center for Psychiatric Rehabilitation, Boston University, Boston, Mass.
Correspondence: Requests for reprints should be sent to Zlatka Russinova, PhD, Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave West, Boston, MA 02215 (e-mail: zlatka{at}bu.edu).
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INTRODUCTION |
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 TOP INTRODUCTION METHODSRESULTSDISCUSSIONReferences |
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Perceived benefit has been identified as an important factor influencing the decision to use alternative medicine for various health problems.1 Although research examining the use of alternative health care practices in the treatment of psychiatric disorders has been increasing,2–7 little is known about the specific benefits experienced by users with mental illness. A few studies4,5 have attempted to address this issue by having respondents assess the extent to which a given practice was experienced as helpful. This report presents preliminary findings on the perceived benefits of alternative health care practices used by adults with serious mental illness (SMI) who participated in a larger exploratory study on the role of such practices in mental health recovery.
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METHODS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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A national purposive nonprobability sample of adults with SMI who reported mental health benefit from alternative health care practices was recruited via Internet announcements, mailings to mental health organizations, notices in newsletters, and word of mouth. Data were collected through a mail survey instrument developed by the first 2 authors and validated through expert review. The survey included several open-ended questions about each alternative practice used by a respondent. Demographic and clinical data were obtained through closed-response items validated and used repeatedly in research conducted by the first 2 authors.
We used respondents’ own labels to code the reported practices. These labels generally were consistent with categories of alternative health care practices reported in the literature.1,4–6 When a respondent did not label a practice, we applied a code based on consensus. For this report, we coded all types of religious and spiritual practices described by respondents into a single broad category. We used an open coding process to inductively develop categories for reported benefits.8–10 Examples of coded benefits include increased emotional stability ("I don’t have panic attacks any more," "It has helped my obsessions to lessen," "I experience fewer symptoms of schizophrenia"); improved concentration ("helps to focus my thoughts," "concentration is better"); increased inner strength/empowerment ("gives me strength," "empowers me"); and increased sense of well-being ("gave me a sense of well-being," "helps me feel better"). We used consensus to code reported benefits and conceptually organized the empirically derived categories into 7 domains of individual functioning: physical, emotional, cognitive, self, social, spiritual, and general.
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RESULTS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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The sample of 157 individuals who completed the survey in 2001 was predominantly middle-aged (mean ± SD = 46.6 ± 10.6 years); 70% were female, 89% White, 67% unmarried, 72% college educated, 39% employed full-time, and 24% employed part-time. Most were diagnosed with bipolar disorder (45%), schizophrenia spectrum disorder (25%), or depressive disorder (25%). Sixty-five percent of respondents reported multiple psychiatric hospitalizations, 86% were currently taking psychotropic medications, and 41% had a coexisting medical condition. Compared with the larger population of persons with SMI in the United States, individuals in our sample were older and more likely to be female, White, college educated, and employed.11
Most respondents (86%) identified multiple practices as beneficial to their mental health. The most frequently reported practices were religious/spiritual activities (50%), meditation (43%), massage (31%), yoga (20%), guided imagery (18%), herbs (16%), chiropractic (13%), and nutritional supplements (13%). Respondents reported using many other practices, including aromatherapy, breathwork, reiki, tai chi, past-life/regression therapy, homeopathy, ayurvedic medicine, acupuncture, acupressure, and reflexology. Table 1
shows the distribution of the most frequently reported practices by psychiatric diagnosis. Compared with respondents with bipolar disorder or major depression, those with schizophrenia spectrum disorders were significantly less likely to use meditation (
22 = 7.57, P = .02) or guided imagery (22 = 6.35, P = .04).
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Benefits attributed to the most frequently reported practices are presented in Table 2
. Although additional benefit categories were established, Table 2 includes only those benefits identified by at least 20% of the users of any of the reported practices. We expect that additional data and further qualitative analysis will lead to the development of a more precise and internally consistent taxonomy of benefits.
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DISCUSSION |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Although preliminary and based on selfreport data from a nonrepresentative sample, these findings increase existing knowledge about the use of alternative health care practices by adults with SMI. First, some individuals with SMI seem to benefit from a variety of alternative practices, including body-manipulation modalities such as massage and chiropractic. More frequently used practices include meditation, massage, yoga, and guided imagery. Second, religious or spiritual activities, such as prayer, worship attendance, and religious or spiritual reading, appear to be commonly practiced and experienced as beneficial by individuals with SMI. Third, alternative practices seem to promote a recovery process beyond the management of emotional and cognitive impairments by also enhancing social, spiritual, general, and self-functioning. Fourth, alternative practices appear to benefit not only individuals diagnosed with the predominantly studied conditions of anxiety and depression3–5 but also persons with the most severe psychiatric disorders. Fifth, psychiatric diagnosis may influence the choice of alternative health care practices. For example, meditation and guided imagery seem to be used less frequently by individuals with a schizophrenia spectrum disorder. Although these findings suggest that alternative health care practices may support the healing and recovery of some persons with SMI, further research is needed to understand the patterns of use and the effects of specific practices on this population.
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Acknowledgments |
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This study was supported by grant H133B90023-00, jointly funded by the National Institute on Disability and Rehabilitation Research and the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.
The authors wish to thank E. Sally Rogers, ScD, for her helpful comments on an earlier draft of this article.
Human Participant Protection
This study was approved by the Boston University Charles River Campus Institutional Review Board.
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Footnotes |
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Z. Russinova conceived and designed the study. Z. Russinova and N. J. Wewiorski developed the survey instrument and implemented the study. All 3 authors analyzed the data, interpreted the results, and wrote the article.
Accepted for publication June 6, 2002.
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References |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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1. Astin JA. Why patients use alternative medicine: results of a national study. JAMA. 1998;279:1548–1553.
2. Beaubrun G, Gray GE. A review of herbal medicines for psychiatric disorders. Psychiatr Serv. 2000;51:1130–1134.
3. Druss BG, Rohrbaugh R, Kosten T, Hoff R, Rosenheck RA. Use of alternative medicine in major depression. Psychiatr Serv. 1998;49:1397.
4. Kessler RC, Soukup J, Davis RB, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry. 2001;158:289–294.
5. Knaudt PR, Connor KM, Weisler RH, Churchill LE, Davidson JRT. Alternative therapy use by psychiatric outpatients. J Nerv Ment Dis. 1999;187:692–695.[Medline]
6. Unutzer J, Klap R, Sturm R, et al. Mental disorders and the use of alternative medicine: results from a national survey. Am J Psychiatry. 2000;157:1851–1857.
7. Wong AH, Smith M, Boon HS. Herbal remedies in psychiatric practice. Arch Gen Psychiatry. 1998;55:1033–1044.
8. Miles MB, Huberman AM. Qualitative Data Analysis. 2nd ed. London, England: Sage Publications; 1994.
9. Silverman D. Interpreting Qualitative Data: Methods for Analysing Talk, Text, and Interaction. London, England: Sage Publications; 1993.
10. Strauss AL, Corbin JM. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd ed. Newbury Park, Calif: Sage Publications; 1998.
11. Manderscheid RW, Henderson MJ, eds. Mental Health, United States, 2000. Rockville, Md: Center for Mental Health Services; 2000.
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