Clinical Practice & Epidemiology in Mental Health




ISSN: 1745-0179 ― Volume 15, 2019

Sailing Can Improve Quality of Life of People with Severe Mental Disorders: Results of a Cross Over Randomized Controlled Trial



Mauro Giovanni Carta 1, *, Federica Maggiani 1, Laura Pilutzu 1, Maria Francesca Moro 1, Gioia Mura 1, Federica Sancassiani 1, Vellante Vellante 1, Gian Mario Migliaccio 1, Sergio Machado 2, Antonio Egidio Nardi 2, Antonio Preti 1
1 Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee – Sardinia
2 Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ)

Abstract

The aim of this study was to evaluate the impact of a sailing rehabilitation program on the quality of life (QoL) in a sample of patients with severe mental disorders. The study adopted a randomized, crossover, waiting-list controlled design. The participants enrolled in the study were outpatients diagnosed with severe chronic mental disorders. The participants (N=40) exposed to rehabilitation with sailing took part in a series of supervised cruises near the gulf of Cagliari, South Sardinia, and showed a statistically significant improvement of their quality of life compared to the control group. This improvement was comparable to the improvement in psychopathologic status and social functioning as shown in a previous report of the same research project. The improvement was maintained at follow-up only during the trial and for a few months later: after 12 months, patients returned to their baseline values and their quality of life showed a worsening trend. This is the first study to show that rehabilitation with sailing may improve the quality of life of people with severe chronic mental disorders. In all likelihood, a program grounded on learning how to manage a sailing vessel - during which patients perform cruises that emphasize the exploration of the marine environment by sailing - might be interesting enough and capture the attention of the patients so as to favour greater effectiveness of standard rehabilitation protocols, but this should be specifically tested.

Keywords: Bipolar disorder, quality of life, rehabilitation, sailing, Schizophrenia. .


Article Information


Identifiers and Pagination:

Year: 2014
Volume: 10
First Page: 80
Last Page: 86
Publisher Id: CPEMH-10-80
DOI: 10.2174/1745017901410010080

Article History:

Received Date: 5/5/2014
Revision Received Date: 12/6/2014
Acceptance Date: 12/6/2014
Electronic publication date: 23 /7/2014
Collection year: 2014

Article Metrics:

CrossRef Citations:
0

Total Statistics:

Full-Text HTML Views: 2400
Abstract HTML Views: 1326
PDF Downloads: 361
Total Views/Downloads: 4087

Unique Statistics:

Full-Text HTML Views: 925
Abstract HTML Views: 754
PDF Downloads: 231
Total Views/Downloads: 1910
Geographical View

© Carta et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, Italy; Tel: +39 35 499994; Fax: +070 6093498; E-mail: mgcarta@tiscali.it





INTRODUCTION

The construct of the quality of life (QoL) deals with subjective well-being and includes somatic and psychological components such as emotional well-being, awareness of one’s skills and disability, possibility of satisfactory sleep and rest, energy and vitality, and general satisfaction about one’s life [1Mantovani G, Astara G, Lampis B , et al. Evaluation by multidimensional instruments of health related quality of life of elderly cancer patients Support Care Cancer 1996; 4: 129-40., 2Carta MG, Aguglia E, Caraci F , et al. Quality of life and ur-ban/rural living preliminary results of a community survey in Italy Clin Pract Epidemiol Ment Health 2012; 8: 169-74.]. In a person suffering from a chronic disorder, QoL is influenced by severity and duration of illness, the side effects of medication, and the stressful events that interfere with the course of the illness [3Bazzichi L, Maser J, Piccinni A , et al. Quality of life in rheumatoid arthritis impact of disability and lifetime depressive spectrum symptomatology Clin Exp Rheumatol 2005; Nov-Dec 23(6): 783-8., 4Mura G, Bhat KM, Pisano A, Licci G, Carta M. Psychiatric symptoms and quality of life in systemic sclerosis Clin Pract Epidemiol Ment Health 2012; 8: 30-5.]. The subjective perception of the quality of life is now considered a construct of relevance for measuring the outcome of chronic disease [5Mantovani G, Astara G, Lampis B , et al. Impact of psychosocial interventions on quality of life of elderly cancer patients Psycho-oncology 1996; 5: 127-35.], particularly for those having a great impact on the daily life of individuals and their relatives [6Carta M, Mura G, Sorbello O, Farina G, Demelia L. Quality of life and psychiatric symptoms in wilson's disease the relevance of bipolar disorders Clin Pract Epidemiol Ment Health 2012; 8: 102-9.]. Consequently QoL has become central to evaluate the efficacy of treatments [7Carta M, Ruggiero V, Sancassiani F , et al. The use of antidepressants in the long-term treatment should not improve the impact of fibromyalgia on quality of life Clin Pract Epidemiol Ment Health 2013; 9: 120-4.].

The most severe psychiatric disorders are chronic; these include several factors that can potentially impair the quality of life. Moreover the disorder-related stigma influences subjective QoL more than in other diseases [8Angermeyer MC, Matschinger H, Carta MG, Schomerus G. Changes in the perception of mental illness stigma in Germany over the last two decades Eur Psychiatry 2013 Dec 6 pii S0924-9338(13)00427-6 doi 101016/jeurpsy201310004 ]. One of the most stigmatizing elements in psychiatric disorders is the feeling that not only is the subject incurable, but also that his/her disabilities are irreversible, such belief having been found deeply rooted in public opinion but also in caregivers [9Higgins A, Callaghan P, DeVries J , et al. Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland a mixed methods pre-postevaluation J Adv Nurs doi 101111/j1365-264805937x Epub 2012, Jan 25 2011; 2012 68(11): 2418-28.]. Sport is socially accepted and doing sports is collectively seen as a symbol of physical and psychological wellbeing. This is why it could serve as a strong antidote against the stigma [10Hardoy MC, Seruis ML, Floris F , et al. Benefits of exercise with mini tennis in intellectual disabilities effects on body image and psychopathology Clin Pract Epidemiol Ment Health 2011; 7: 157-60.]. Physical exercise and sports activities have often been used as a tool for the rehabilitation of patients with severe psychiatric disorders [11Mura G, Moro MF, Patten SB, Carta MG. Exercise as an add-on strategy for the treatment of major depressive disorder a systematic review CNS Spectr 2014; Mar 3: 1-13.] but never before our research project [12Carta MG, Maggiani F, Pilutzu L , et al. Sailing for rehabilitation of patients with severe mental disorders results of a cross over randomized controlled trial Clin Pract Epidemiol Ment Health 2014; 10: 73-9.] were they investigated through a randomized controlled trial by means of standardized assessment tools. In a previous study we have shown how a program of learning to sail and practicing improved the clinical symptoms and social skills of a group of patients with chronic psychosis [12Carta MG, Maggiani F, Pilutzu L , et al. Sailing for rehabilitation of patients with severe mental disorders results of a cross over randomized controlled trial Clin Pract Epidemiol Ment Health 2014; 10: 73-9.]. The purpose of this paper is to illustrate how this same program has also improved some components of the quality of life, a construct linked to a modern vision of recovery, in people with severe psychosis [13Ramon S, Healy B, Renouf N. Recovery from mental illness as an emergent concept and practice in Australia and the, UK Int J Soc Psychiatry 2007; 53(2): 108-22.].

METHODS

The study was supported by the Sardinian Regional Authority and the study protocol was approved by the Board of the “Centro di Programmazione della Regione Sardegna” (Planning Center of the Region of Sardinia) and by the Institutional review board of the Università Europea del Mediterraneo ONLUS. The study procedures were in agreement with the 1995 Declaration of Helsinki (revised in 2004 in Tokyo). Informed consent was obtained from all the participants.

Study Sample and Design

The methodology (randomized controlled, crossover clinical trial) and the timing of the study have been described in detail in the previous publication about this study [12Carta MG, Maggiani F, Pilutzu L , et al. Sailing for rehabilitation of patients with severe mental disorders results of a cross over randomized controlled trial Clin Pract Epidemiol Ment Health 2014; 10: 73-9.]. The two cross over arms were: a) rehabilitation with sailing plus current drug treatment in the first year and (in the second year) current drug treatment plus traditional rehabilitation program with self-help group discussion and work therapy; b) in the first year, traditional rehabilitation program (similarly to the second year of the first group) plus current drug treatment; and the sailing program in addition to current drug treatment in the second year.

The 40 participants were required to have a diagnosis of schizophrenia, affective psychoses, or severe personality disorders [14World Health Organisation In: International Classification of Diseases (ICD) 10th Revision (ICD-10) Geneva WHO 1990 . ], to have been for no less than two years in treatment in a mental health care network, and to have reached clinical remission without any crisis in the past four months. Recruitment, randomization methods, and issues concerning blinding have been already described as well [12Carta MG, Maggiani F, Pilutzu L , et al. Sailing for rehabilitation of patients with severe mental disorders results of a cross over randomized controlled trial Clin Pract Epidemiol Ment Health 2014; 10: 73-9.].

Intervention

The description of the program including bi-monthly sailing cruises in the Gulf of Cagliari and lessons about sailing ships and sea life have also been detailed in the previously cited publication, as was also the equipment of the boat – including a hydrophone for recording or listening to underwater sounds with particular attention to the movements of shoals of cetaceans.

Assessment

Quality of life was evaluated on a 6-month basis since baseline with the WHOQOL-Bref. The WHOQOL-Bref is an abbreviated version of the WHOQOL-100 quality of life instrument [15 World Health Organization In: WHOQOL Group 1998 Development of the World Health Organization WHOQOL-BREF quality of life assessment Psychol Med. 551-8.] which construct of quality of life is consistent with that of the WHO: "the value assigned to duration of life as modified by the impairments, functional states, perceptions, and social opportunities that are influenced by disease, injury, treatment, or policy" [15 World Health Organization In: WHOQOL Group 1998 Development of the World Health Organization WHOQOL-BREF quality of life assessment Psychol Med. 551-8.].

WHOQOL-Bref measures four components of quality of life as physical health, psychological health, social relationships and environment [16 World Health Organization WHOQOL-Bref Introdution administration, scoring and assessment of the generic version field trial version Geneva 1996..]. The Italian version adopted in this survey shows satisfactory psychometric properties [17De Girolamo G, Rucci P, Scocco P , et al. Quality of life assessment validation of the Italian version of the WHOQOL-Bref Epidemiol Psichiatr Soc 2000; 9: 45-55.]. The items are coded on a 5-point Likert scale. The range of scores is 4 to 20 for each component, higher score indicating better quality of life.

All 3 raters had two years or more of professional experience with people suffering from severe mental disorders. They were trained in the administration of WHOQOL-Bref. The measure of intra-class correlation (ICC) coefficient at baseline did not change in repeated assessments over time.

Statistics

The Statistical Package for Social Science 17 (SPSS) for Windows was employed for data analysis. Because of multiple testing, tests were two-tailed; threshold of significance was set at p < .0001 according to Bayesian interpretations, to have the highest chance of confirmation in future studies [18Katki HA. Invited commentary evidence-based evaluation of p values and Bayes factor Am J Epidemiol 2008; 168: 384-8.]. To test sample differences Student’s test for mean differences was adopted. A general linear model (GLM) that accounts for repeated measurements over time was used. Greenhouse-Geisser was applied to account for violation of sphericity.

RESULTS

Table 1 - describing the 40 participants (38 males) by sex, age, education level, marital status, and diagnosis - has already been published in the previous publication. There were no statistically significant differences between the two groups concerning major socio-demographic variables and the clinical measures at baseline. Patients in Group B were generally younger than those in Group A (Table 1). The same table shows also the:

Table 1

Baseline socio-demographic and clinical characteristics of the patients enrolled in the study.




Table 2

Changes over time in measures of quality of life (The figure shows the groups in the time sequence of the cross-over design).




Effects of exposition to rehabilitation with sailing over time

In Group A, 2 participants dropped out, one in the second month and the other in the third.

In Group B, 5 participants dropped out in the 13th month (one month after the start of the sailing program for this group).

There was a statistically significant (Table 2) effect of time by group (treated cases versus controls) on WHOQOL-Bref Physical health subscale, F(1, 68) = 63.90, p < .0001 (partial eta-squared = .48); Psychological health subscale, F(1, 69) = 10.65, p = .002 (partial eta-squared = .13); and Environment subscale, F(1, 69) = 34.17, p < .0001 (partial eta-squared = .33), but not on the WHOQOL-Bref Social relationships subscale, F(1, 69) = 0.49, p = .48 (partial eta-square = .01).

According to the effect sizes of the effects (partial eta-squared), changes in the Physical health and the Environment subscales were more important than the changes in the Psychological health subscale.

However once the program came to an end the effects disappeared, and in the subgroup for which we were able to collect data at the follow-up (n = 18) the scores on the four WHOQOL-Bref subscales measured at the 12-month follow-up returned back to the baseline values (Fig. 2).

Fig. (1)

Distribution of scores on the WHOQoL-Bref by subscale at baseline and at end of treatment in treated cases and in controls.



Fig. (2)

Distribution of scores on the WHOQoL-Bref by subscale at baseline, end of treatment, 6-month and 12-month follow-up in treated cases.



Trend analysis showed that a quadratic model (rising and then falling trend) had the best fit for the changes over time in the four WHOQOL-Bref subscales in the subgroup with data at follow-up (p < .001 or lower).

DISCUSSION

The people with severe mental disorders who participated to a “rehabilitation with sailing” program that included a series of cruises in the gulf of Cagliari (Sardinia), showed a statistically significant improvement of their quality of life and, as already indicated, of their clinical status and general functioning as well [12Carta MG, Maggiani F, Pilutzu L , et al. Sailing for rehabilitation of patients with severe mental disorders results of a cross over randomized controlled trial Clin Pract Epidemiol Ment Health 2014; 10: 73-9.]. The changes in the Physical health and and the Environment components of QoL were more important than those concerning Psychological health, while Social relationships did not improve at all. QoL improvement was not stable at follow-up: after 12 months patients showed a worsening trend for their quality of life in line with their baseline values’ returning to the scores achieved on the psychopathology and functioning scales in the previous study [12Carta MG, Maggiani F, Pilutzu L , et al. Sailing for rehabilitation of patients with severe mental disorders results of a cross over randomized controlled trial Clin Pract Epidemiol Ment Health 2014; 10: 73-9.].

Strong evidence supported by literature shows that exercise is significantly beneficial to people with severe mental disorders on both the biological and the psychological levels [19Knöchel C, Oertel-Knöchel V, O'Dwyer L , et al. Cognitive and behavioural effects of physical exercise in psychiatric patients Prog Neurobiol 2012; Jan 96(1): 46-8., 20Helmich I, Latini A, Sigwalt A , et al. Neurobiological alterations induced by exercise and their impact on depressive disorders [corrected] Clin Pract Epidemiol Ment Health 2010; Nov 30 6: 115-25.]. Not only did exercise reduce psychopathological symptoms, but it also improved metabolic responses and neuro-protection, and increased QoL [20Helmich I, Latini A, Sigwalt A , et al. Neurobiological alterations induced by exercise and their impact on depressive disorders [corrected] Clin Pract Epidemiol Ment Health 2010; Nov 30 6: 115-25.]. Due to this evidence the proposal was advanced of integrating physical activity into a patient's social life in therapeutic regimes within the context of multi-modal therapeutic programs, as a strategy to improve the quality of live and reduce physical illness [20Helmich I, Latini A, Sigwalt A , et al. Neurobiological alterations induced by exercise and their impact on depressive disorders [corrected] Clin Pract Epidemiol Ment Health 2010; Nov 30 6: 115-25.].

The gradual transition from traditional neuroleptics to atypical neuroleptics in the current treatment of severe mental illness has facilitated, on the one side, the motor activity of the patient by reducing the incidence of extrapyramidal effects; but on the other it makes the patient more vulnerable to weight gain and dysmetabolic syndrome [21Vancampfort D, De Hert M, Sweers K, De Herdt A, Detraux J, Probst M. Diabetes, physical activity participation and exercise capacity in patients with schizophrenia Psychiatry Clin Neurosci 2013; Sep 67(6): 451-6.]. Thus with the current treatment regimens, patients can more easily make physical activity, since the same new drugs making exercise more accessible also produce undesirable symptoms that are mitigated by exercise [22Abdel-Baki A, Brazzini-Poisson V, Marois F, Letendre E, Karelis AD. Effects of aerobic interval training on metabolic complications and cardiorespiratory fitness in young adults with psychotic disorders a pilot study Schizophr Res 2013; Sep 149(1-3): 112-5.]. However, the improvement in quality of life produced by sailing in our sample certainly depends upon more general and complex aspects although it may have a relationship with the improvement of body awareness and of the physical skills of participants, as emerged specifically from the physical scale. The concept of QoL is related to the subjective view of one’s satisfaction, thus the net improvement felt by patients during the rehabilitation of our sample could not be just a consequence of the improvement in symptoms and in skills due to physical activity only. The psychological health subscale, which shows a clear improvement in the trials, measures dimensions such as positive feelings, self-esteem, thinking, learning, memory and concentration, spirituality, religion, and personal beliefs that cannot be improved with physical exercise only and directly. While other dimensions of the same scale as Body image do. And the “environment” subscale, which also shows a clear improvement for the people participating in the trial, measures items related to self-safety in the environment where physical efficiency may be only one of the complex determinants.

This inspiring experience involves learning new socially recognized skills, while living in a supportive and challenging climate is an added value of the proposed route. From this point of view it is difficult to decompose the complex elements of the intervention implemented in this study to test whether the improvement is specifically due to some of them: the program involved multiple new experiences for the participants, such as learning to collaborate on a ship as a crew, experiencing community life with the crew on board, learning to use hydrophones to search for dolphins. Readers can guess what this experience might have meant ​to these people, who have missed some aspects of pleasure in their lives because of the disease. The study makes it clear how important it is for a rehabilitation program to enable a person live experiences that can restore hope in a better life. In this sense a captivating experience may interrupt the evolution into chronicity, which is sometimes favored by the scarcity of stimuli and an impaired quality of life [23Carta MG, Agaj A, Harapej E , et al. Outcomes of discharged females versus those waiting for discharge from Vlore Psychiatric Hospital (Albania) Int J Soc Psychiatry 2013; Nov 59(7): 682-9.].

This is related to a new way of seeing rehabilitation in severe psychiatric disorders that exceed the concept whereby psychoses, and schizophrenia in particular, are progressive degenerative diseases with an inevitable evolution towards “defective” forms, as stated in the past in Kraepelin’s theories [24Kraepelin E, Ed. Dementia Praecox and Paraphrenia Lenox MA: Hardpress Publihing 2013.]. The current theories have totally revolutionized this point of view. The modern concepts based on the hypothesis of an error of neurodevelopmental migration of neurons consider the biological damage at the basis of the disorder to be stable over time and not to evolve; consequentially functional improvement is possible through proper rehabilitation programs [25Mura G, Petretto DR, Krishna MB, Carta MG. Schizophrenia from epidemiology to rehabilitation Clin Pract Epidemiol Ment Health 2012; 8: 22-7.]. Recently a more optimistic way to consider the possibility of recovery from these disorders has taken root. This approach sees recovery more as a personal goal than the achievement of a standardized outcome [26Silverstein SM, Bellack AS. A scientific agenda for the concept of recovery as it applies to schizophrenia Clin Psychol Rev 2008; 28: 1108-24.-28Carta M, Sancassiani F, Lecca M , et al. Coping with the crisis people with severe mental disorders acting for social change through sustainable energy Clin Pract Epidemiol Ment Health 2013; Nov 28 9: 214-20.]. For a person it may mean developing hope in the future, a secure base, a network of supportive relationships, empowerment, social and work inclusion, coping skills [29Sells DJ, Stayner DA, Davidson L. Recovering the self in Schizophrenia an integrative review of qualitative studies Psychiatr Q 2004; 75(1): 87-97.]. The recovery of a coherent and solid sense of the self has been proposed as the main element in this approach considering that illness may have broken or destroyed the awareness of self [23Carta MG, Agaj A, Harapej E , et al. Outcomes of discharged females versus those waiting for discharge from Vlore Psychiatric Hospital (Albania) Int J Soc Psychiatry 2013; Nov 59(7): 682-9., 30Carta MG, Balestrieri M, Murru A, Hardoy MC. Adjustment disorder epidemiology, diagnosis and treatment Clin Pract Epidemiol Ment Health 2009; 5: 15.]. Building a positive sense of self can be facilitated by experiences of interpersonal acceptance, mutuality, and a sense of belonging to a group of peers; and it is often challenging in the face of stigmatization barriers [31Dunn EC, Wewiorski NJ, Rogers ES. The meaning and importance of employment to people in recovery from serious mental illness results of a qualitative strudy Psychiatr Rehabil J 2008; 32: 59-62.]. Sports activities can enhance those components that support the process that builds a good sense of self: achieving socially-recognized sports skills, supporting self-esteem and self-confidence, discovering communication skills, favouring group membership, improving knowledge and awareness of the body [32Carta MG, Hardoy MC, Pilu A , et al. Improving physical quality of life with group physical activity in the adjunctive treatment of major depressive disorder Clin Pract Epidemiol Ment Health 2008; 26: 1.-35Mura G, Carta MG. Physical activity in depressed elderly.A systematic review Clin Pract Epidemiol Ment Health 125-35 doi 102174/1745017901309010125 2013; Jul 12 9]. Learning to sail - as experienced in this study - can provide added value, and facilitate recovery paths thanks to items such as: going out with a group where experts stimulate the sense of belonging; experiencing a new sense of autonomy and freedom while going out to sea and acquiring the knowledge required to manage a boat [36Hegemann T. Rehabilitative success of a social therapy sailing project Prax Kinderpsychol Kinderpsychiatr 1991; 40(2): 61-6.]; and specifically for the proposed program, learning new and unusual stimuli such as the sounds of marine mammals [37Basil B, Mathews M. Human and animal health strengthening the link methodological concerns about animal facilitated therapy with dolphins BMJ 2005; 331: 1407.].

We must stress, however, that at the follow-up, patients’ level of QoL returned to the level preceding the trial. This suggests that a more fulfilling experience for the participants may make sense only when placed in a more complex rehabilitation path.

LIMITATIONS

The small sample size has limited this study, anyway, the crossover design limits the power of the confounding covariates and requires fewer subjects than a parallel design [38Jone BK, Michael G, Eds. Design and analysis of cross-over trials London: Chapman and Hall 2003.], and this has partially balanced this limit.

Another limit was the impossibility of a blind assessment because patients talked enthusiastically about the cruises.

CONCLUSION

This is the first study to show that rehabilitation with sailing may impact positively on the quality of life of patients with severe mental disorders, albeit over a limited period of time. The study suggests that strong motivating experiences may be a useful rehabilitation tool in cronic mental disorders. Future research may explain if a motivating experience like sailing could be the first step in a planned, multimodal approach to rehabilitation.

CONFLICT OF INTEREST

The authors confirm that this article content has no conflict of interest.

ACKNOWLEDGEMENTS

Dr FM and Dr LP have received financial support by the Regione Autonoma della Sardegna (Grant no. CRP3_165, PO Sardegna FSE 2007-2013, according to regional law L.R. 7/2007 “Promozione della ricerca scientifica e dell'innovazione tecnologica in Sardegna”). Professor MC was the senior investigator of the program. The Regione Sardegna had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. No other forms of financial support were received for this study.

Study Design: MGC, FM and LP

Data Collection and Analysis: FM, LP, FS, MV, SM, AEN, AP, MFM, GMMand MGC

Manuscript Preparation: MGC, MFM, AP, FM, LP, SM and AEN

REFERENCES

[1] Mantovani G, Astara G, Lampis B , et al. Evaluation by multidimensional instruments of health related quality of life of elderly cancer patients Support Care Cancer 1996; 4: 129-40.
[2] Carta MG, Aguglia E, Caraci F , et al. Quality of life and ur-ban/rural living preliminary results of a community survey in Italy Clin Pract Epidemiol Ment Health 2012; 8: 169-74.
[3] Bazzichi L, Maser J, Piccinni A , et al. Quality of life in rheumatoid arthritis impact of disability and lifetime depressive spectrum symptomatology Clin Exp Rheumatol 2005; Nov-Dec 23(6): 783-8.
[4] Mura G, Bhat KM, Pisano A, Licci G, Carta M. Psychiatric symptoms and quality of life in systemic sclerosis Clin Pract Epidemiol Ment Health 2012; 8: 30-5.
[5] Mantovani G, Astara G, Lampis B , et al. Impact of psychosocial interventions on quality of life of elderly cancer patients Psycho-oncology 1996; 5: 127-35.
[6] Carta M, Mura G, Sorbello O, Farina G, Demelia L. Quality of life and psychiatric symptoms in wilson's disease the relevance of bipolar disorders Clin Pract Epidemiol Ment Health 2012; 8: 102-9.
[7] Carta M, Ruggiero V, Sancassiani F , et al. The use of antidepressants in the long-term treatment should not improve the impact of fibromyalgia on quality of life Clin Pract Epidemiol Ment Health 2013; 9: 120-4.
[8] Angermeyer MC, Matschinger H, Carta MG, Schomerus G. Changes in the perception of mental illness stigma in Germany over the last two decades Eur Psychiatry 2013 Dec 6 pii S0924-9338(13)00427-6 doi 101016/jeurpsy201310004
[9] Higgins A, Callaghan P, DeVries J , et al. Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland a mixed methods pre-postevaluation J Adv Nurs doi 101111/j1365-264805937x Epub 2012, Jan 25 2011; 2012 68(11): 2418-28.
[10] Hardoy MC, Seruis ML, Floris F , et al. Benefits of exercise with mini tennis in intellectual disabilities effects on body image and psychopathology Clin Pract Epidemiol Ment Health 2011; 7: 157-60.
[11] Mura G, Moro MF, Patten SB, Carta MG. Exercise as an add-on strategy for the treatment of major depressive disorder a systematic review CNS Spectr 2014; Mar 3: 1-13.
[12] Carta MG, Maggiani F, Pilutzu L , et al. Sailing for rehabilitation of patients with severe mental disorders results of a cross over randomized controlled trial Clin Pract Epidemiol Ment Health 2014; 10: 73-9.
[13] Ramon S, Healy B, Renouf N. Recovery from mental illness as an emergent concept and practice in Australia and the, UK Int J Soc Psychiatry 2007; 53(2): 108-22.
[14] World Health Organisation In: International Classification of Diseases (ICD) 10th Revision (ICD-10) Geneva WHO 1990 .
[15] World Health Organization In: WHOQOL Group 1998 Development of the World Health Organization WHOQOL-BREF quality of life assessment Psychol Med. 551-8.
[16] World Health Organization WHOQOL-Bref Introdution administration, scoring and assessment of the generic version field trial version Geneva 1996..
[17] De Girolamo G, Rucci P, Scocco P , et al. Quality of life assessment validation of the Italian version of the WHOQOL-Bref Epidemiol Psichiatr Soc 2000; 9: 45-55.
[18] Katki HA. Invited commentary evidence-based evaluation of p values and Bayes factor Am J Epidemiol 2008; 168: 384-8.
[19] Knöchel C, Oertel-Knöchel V, O'Dwyer L , et al. Cognitive and behavioural effects of physical exercise in psychiatric patients Prog Neurobiol 2012; Jan 96(1): 46-8.
[20] Helmich I, Latini A, Sigwalt A , et al. Neurobiological alterations induced by exercise and their impact on depressive disorders [corrected] Clin Pract Epidemiol Ment Health 2010; Nov 30 6: 115-25.
[21] Vancampfort D, De Hert M, Sweers K, De Herdt A, Detraux J, Probst M. Diabetes, physical activity participation and exercise capacity in patients with schizophrenia Psychiatry Clin Neurosci 2013; Sep 67(6): 451-6.
[22] Abdel-Baki A, Brazzini-Poisson V, Marois F, Letendre E, Karelis AD. Effects of aerobic interval training on metabolic complications and cardiorespiratory fitness in young adults with psychotic disorders a pilot study Schizophr Res 2013; Sep 149(1-3): 112-5.
[23] Carta MG, Agaj A, Harapej E , et al. Outcomes of discharged females versus those waiting for discharge from Vlore Psychiatric Hospital (Albania) Int J Soc Psychiatry 2013; Nov 59(7): 682-9.
[24] Kraepelin E, Ed. Dementia Praecox and Paraphrenia Lenox MA: Hardpress Publihing 2013.
[25] Mura G, Petretto DR, Krishna MB, Carta MG. Schizophrenia from epidemiology to rehabilitation Clin Pract Epidemiol Ment Health 2012; 8: 22-7.
[26] Silverstein SM, Bellack AS. A scientific agenda for the concept of recovery as it applies to schizophrenia Clin Psychol Rev 2008; 28: 1108-24.
[27] Nordén T, Malm U, Norlander T. Resource Group Assertive Community Treatment (RACT) as a tool of empowerment for clients with severe mental illness a meta-analysis Clin Pract Epidemiol Ment Health 2012; 8: 144-51.
[28] Carta M, Sancassiani F, Lecca M , et al. Coping with the crisis people with severe mental disorders acting for social change through sustainable energy Clin Pract Epidemiol Ment Health 2013; Nov 28 9: 214-20.
[29] Sells DJ, Stayner DA, Davidson L. Recovering the self in Schizophrenia an integrative review of qualitative studies Psychiatr Q 2004; 75(1): 87-97.
[30] Carta MG, Balestrieri M, Murru A, Hardoy MC. Adjustment disorder epidemiology, diagnosis and treatment Clin Pract Epidemiol Ment Health 2009; 5: 15.
[31] Dunn EC, Wewiorski NJ, Rogers ES. The meaning and importance of employment to people in recovery from serious mental illness results of a qualitative strudy Psychiatr Rehabil J 2008; 32: 59-62.
[32] Carta MG, Hardoy MC, Pilu A , et al. Improving physical quality of life with group physical activity in the adjunctive treatment of major depressive disorder Clin Pract Epidemiol Ment Health 2008; 26: 1.
[33] Pilu A, Sorba M, Hardoy MC , et al. Efficacy of physical activity in the adjunctive treatment of major depressive disorders preliminary results Clin Pract Epidemiol Ment Health 2007; Jul 9 3: 8.
[34] Mura G, Sancassiani F, Migliaccio GM, Collu G, Carta MG. The association between different kinds of exercise and quality of life in the long term.Results of a randomized controlled trial on the elderly Clin Pract Epidemiol Ment Health 2014; 10: 36-41.
[35] Mura G, Carta MG. Physical activity in depressed elderly.A systematic review Clin Pract Epidemiol Ment Health 125-35 doi 102174/1745017901309010125 2013; Jul 12 9
[36] Hegemann T. Rehabilitative success of a social therapy sailing project Prax Kinderpsychol Kinderpsychiatr 1991; 40(2): 61-6.
[37] Basil B, Mathews M. Human and animal health strengthening the link methodological concerns about animal facilitated therapy with dolphins BMJ 2005; 331: 1407.
[38] Jone BK, Michael G, Eds. Design and analysis of cross-over trials London: Chapman and Hall 2003.

Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents




Webmaster Contact: info@benthamopen.net
Copyright © 2019 Bentham Open