Capacidade física, funcional e funcionalidade em indivíduos com transtornos mentais: estudo transversal multicêntrico

Abstract

Mental disorders are one of the leading causes of disability worldwide and are among the top ten global causes of the increasing burden of disease. Changes in physical health may be associated with the functioning of this population. However, there are still gaps in the literature that can link functioning and measures aimed at physical and functional capacity. Measures of handgrip strength and functional exercise capacity have potential utility as markers associated with the level of functioning in individuals with mental disorders, as they are part of the functioning construct, according to the International Classification of Functioning, Disability, and Health (ICF). However, elements of physical health that could impact the functioning of this population were little explored. Therefore, the objective of this study was to verify the association between the level of functioning with the handgrip strength and the functional capacity of exercise of individuals with mental disorders. A cross-sectional, multicenter study was carried out in partnership with researchers from the Federal University of Santa Maria (UFSM) and Federal University of Ceará (UFC) institutions. We collected data from 75 outpatients with an established medical diagnosis of schizophrenia, major depression, bipolar disorder, or anxiety disorders, aged between 18 and 65 years. The primary outcome was the level of functioning assessed using WHODAS 2.0 in the 12-item version. Independent variables were handgrip strength and functional exercise capacity, measured using the 2-minute walk test (2MWT). We also collected sociodemographic information, time of physical activity and sedentary behavior (SIMPAQ), the severity of psychiatric symptoms (MST-1), and comorbidities (SCQ). Descriptive, correlational, and multiple linear regression analyzes were performed to analyze the association of the level of functioning with secondary outcomes, adjusted for clinical covariates. Participants' mean functioning score was 32.19 (± 18.05) in a total of 100 points. The mean distance covered was 151.53 ± 31.49 meters, while the mean value of handgrip strength was 31.20 ± 11.43 kilograms-force. Handgrip strength and functional exercise capacity were significantly and inversely associated with the WHODAS 2.0 score, that is, the higher the handgrip strength and functional exercise capacity, the higher the level of functioning. A multiple linear regression model showed that handgrip strength (Beta -0.194 95% CI: -0.593 -0.013) and functional exercise capacity (Beta -0.219, 95% CI: -0.235 -0.016) were significant independent predictors of the variance of the level of functioning, being adjusted by the collection center, age, education level and the severity of psychiatric symptoms. Our findings suggest the importance of incorporating these physical health assessment measures into mental health care, which can help identify intervention targets and explore their effects on improving functioning. In addition, it reflects the need for integrated and interprofessional health care to assess and monitor the level of functioning of this population.