Exploring adolescents’ physical activity and physical health in a secure psychiatric hospital

Research has indicated that adolescents in secure psychiatric care engage in significantly less physical activity (PA) and more sedentary behaviour (SB) than their peers. These behavioural factors play a significant contribution to the poor physical health, and subsequent premature mortality reported by populations with severe mental illness (SMI).

Despite a growing body of research exploring PA promotion for adults with SMI, adolescents with SMI receive significantly less attention in the research literature. However, they present a group vulnerable group to the poor physical health consequences of SMI which may extend into adulthood. Driven by the lack of literature within this population, this PhD aimed to understand the physical health risks for adolescents in secure care, in addition to exploring the role of PA and a reduction in SB, both in improving the physical health of adolescents in secure care, but also contributing to their wider mental and physical wellbeing.

To address these research aims; four empirical studies were developed. Firstly, a scoping review explored the literature on PA for adolescents with SMI. Secondly, to understand factors underlying PA provision in secure care, interviews with physical health practitioners, clinical staff and patients explored the barriers, facilitators, and perceived benefits of PA whilst in secure care. Findings supported that of study 1 but highlighted that for PA promotion and physical health support to become embedded within the environment, collaboration and support is needed from a wider network of staff members. Next, to understand the physical health implications of secure care, a longitudinal analysis explored weight change from admission to discharge for adolescents in secure care. Findings indicated that adolescents do gain weight in secure care, with individual differences contributing to varying BMI trajectories. Finally, to explore the wider benefits of a reduction in SB we analysed data exploring the association between grounds leave during a period of national lockdown and incidents of self-harm and violence. This provides an early indication that access to leave may be associated, acutely with lower reported incidents.

This thesis presents an important contribution to early intervention research for adolescents in secure psychiatric care. Findings from this thesis have implications for both research and practice for both PA promotion and physical health considerations for adolescents in secure psychiatric care.