For People with Serious Mental Illness, Spending Quality Time in Important Activities May be Connected to Reducing Depressive Symptoms

A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Serious mental illnesses are mental, emotional, and behavioral disorders such as bipolar disorder, schizophrenia, and depression that can severely inhibit or interfere with an individual’s ability to function and participate in major life activities. Research has shown that people with serious mental illness may be more likely than others to experience depressive symptoms such as feelings of sadness, loss of interest in normal activities, insomnia, and irritability. They may withdraw from social relationships, which in turn could lead to a lower quality of life and suicidal ideation. Community participation such as employment, education, and leisure activities has been shown to help people with serious mental illness reduce the likelihood of experiencing depressive episodes.  

In a recent NIDILRR funded study, researchers wanted to explore whether changes in community participation were associated with changes in depressive symptoms among people with serious mental illnesses. Researchers wanted to know if increased or decreased community participation over time resulted in a corresponding increase or decrease in depression levels. They also wanted to know if changes in the amount of time spent in participation, the number of activities participants deemed important to them, and whether they felt they spent enough time participating in these important activities had an effect on their depressive symptoms.

Researchers at the Rehabilitation Research and Training Center on Participation and Community Living of Individuals with Psychiatric Disabilities looked at previously collected data from two trials of interventions for people with serious mental illness. Both studies had participants between 18-65 years old who had received a diagnosis of a serious mental illness and were receiving community mental health services. As part of these previous studies, all participants answered questions at the beginning of the trials and either 12 months or 24 months later about whether they experienced any depressive symptoms and about their participation in community activities. To measure depressive symptoms, participants reported how much they were bothered by depressive symptoms such as feeling blue, worthless feeling, and feeling no interest in things in the previous week. To measure their community participation, they answered questions about engaging in any of 21 areas of community activities such as going to the park, watching a sports event, working for pay, and visiting family and friends, among others. Participants reported how many days out of the past month they did each activity, how important they viewed each activity, and whether they did them enough, not enough, or too much.

The researchers combined the data from both studies to compare community participation and depression levels between the two data collection points. The researchers looked at changes in the number of activity days in which the participants engaged overall; the number of important activities; the time spent in these important activities; the participants’ satisfaction with participation; and any changes in depression levels. The results showed that community participation was correlated with depressive symptoms. Specifically, the researchers found that, over time:

• Depressive symptoms increased when participants increased the number of areas of participation they identified as important.
• Depressive symptoms decreased when participants engaged in a larger number of activities that were important to them.
• Depressive symptoms decreased when participants labeled their engagement in more important activities as enough.
• An increase in the amount of participation alone did not result in a change in depressive symptoms.

According to the authors, findings of this study show that the time spent engaging in important activities and the satisfaction with that engagement were more important in decreasing depressive symptoms than just increasing participation overall. The authors suggested that participants who deemed larger numbers of community activities as important may have felt overwhelmed with the resources required to partake in the larger number of activities and may have faced barriers to accessing them. This may have led to the participants feeling unsatisfied with their level of participation and an increase in their depressive symptoms.

The authors noted that community participation can be a vital tool in the treatment of depression among people with serious mental illness. Practitioners may want to assist their clients with serious mental illness in identifying those community activities which they may find most meaningful and important. Identifying and addressing potential barriers to community participation could also aid people with serious mental illnesses in engaging with community activities that are important to them. 

To learn more

The Rehabilitation Research and Training Center on Participation and Community Living for People with Psychiatric Disabilities offers a large collection of resources to support participation of people with serious mental illness, including guides, programs, calendars, and other tools for individuals and practitioners.

NARIC’s Research In Focus series has looked at the connection between community participation and mental health:

• For People with Serious Mental Illness, Getting Out and About May be Good for the Brain
• Community Mental Health Center Visits May Increase Community Participation for People with Serious Mental Illness
• Community Participation Can Boost Self-Determination for Individuals with Serious Mental Illness

To learn more about this study

Nagata, S., McCormick, B., Brusilovskiy, E., Salzer, MS. (2022). Community participation as a predictor of depressive symptoms among individuals with serious mental illness. International Journal of Social Psychiatry, 68(8), 1689–1697. This article is available from the NARIC collection.