Dietary challenges and desired support strategies in patients with severe mental illness: insights from a qualitative focus group study.

Objectives: Patients with severe mental illnesses (SMI), such as schizophrenia and depression, face significant challenges in maintaining healthy dietary habits. However, in practice, easily accessible and available options for nutritional support in psychiatric settings remain lacking. This study aimed to identify the specific difficulties faced by these patients and explore the types of support they find most beneficial.

Methods: Using a qualitative, participatory approach we conducted six focus groups with 4-9 patients from the Psychiatric University Hospital Zurich between September and December 2023. The interviews were guided by a pre-developed discussion guideline and analyzed using MAXQDA with qualitative content analysis based on Graneheim and Lundman's approach. A deductive-inductive method was chosen for coding the transcripts.

Results: A total of 38 patients (50% female, 23-61 years, 92% with depression, 5% with schizophrenia, 3% did not state the diagnosis) described a range of difficulties related to meal preparation and cooking, emotional eating, and medical factors, all compounded by overarching problems regarding daily structure and feelings of resignation. Participants were open to a variety of support options, with preference for practical hands-on support from mental health professionals to help translate their knowledge into action (e.g. support with shopping or meal planning). Participants wanted to be actively asked about nutrition problems.

Discussion: The findings highlight the complex interplay of cognitive, emotional, and practical barriers to healthy eating in patients with SMI. There is a need for integrated nutritional support within psychiatric care, emphasizing the importance of practical, personalized, and proactive interventions.