The Development of a Nutrition Screening Tool for Mental Health Settings: The NutriMental Screener

A 2019 systematic review of studies identifying the dietary intake of people with severe mental illness (SMI) revealed that people with SMI were found to have significantly higher dietary energy and sodium intake compared with controls, and that higher energy and sodium intakes were associated with poorer diet quality and eating patterns (Teasedale et al., 2019). Another study exploring the self-reported dietary habits of acute psychiatric inpatients found that 75% of the psychiatric inpatients had an unhealthy diet (Gill et al., 2021). 

 

No dietary assessment tool or method has been validated specifically in people with SMI to date.

 

Those who use mental health services are at risk for common nutrition concerns. These risks, combined with the known physical-health disparities and life expectancy gaps existing for people with serious mental illness (SMI), make it important to identify and develop assessment tools that can be used by mental health professionals to determine the diet of an individual who uses mental health services. A recent study by Teasdale, Moerkl, Moetteli, and Mueller-Stierlin (2021) outlines the development of such a screener tool for use by mental health professionals to assess patient diet.

 

It is important to identify and develop assessment tools that can be used by mental health professionals to determine the diet of an individual who uses mental health services.

 

The NutriMental Screener is a nutrition and eating-behavior risk-screening tool being developed for use in clinical practice to identify mental-health service users with potential nutrition risks, including both overnutrition and undernutrition. This screener tool could be used to trigger a referral to a specialist clinician (i.e. dietitian/ clinical nutritionist). 

 

The NutriMental Screener is a nutrition and eating-behavior risk-screening tool being developed for use in clinical practice.

 

The development and validation processes associated with developing the NutriMental Screener are divided into five phases. 

Phase I, which has already been completed, entails the development of nutrition-related risk factors and their related themes of interest collected from screening tools used in mental health services. 

Phase II, which is partially completed, entails reviewing published literature and conducting service-user interviews across three mental health sites to gain a better understanding of the main concerns and challenges that people with SMI face in terms of eating patterns, filling gaps, and identifying additional domains. 

Phase III, involves researchers identifying key elements that will be used in creating the first draft of the screening tool. This entails the formation of an international working group of relevant stakeholders (including dietitians, psychiatrists, clinical psychologists, nursing specialists, and peer workers) and people with SMI, who will all take part in two online workshops and an online survey to discuss the NutriMental Screening’s rationale and overall design, as well as the domains and themes identified in Phases I and II.  

Phase IV, involves the developed tool being pilot tested and studied in various multinational mental health facilities to determine its feasibility and preliminary validation. 

Phase V, the final phase, involves carrying out the previously required changes and alterations, followed by formal validation studies which include comparing results to validated nutrition and eating-related questionnaires, testing for associations with the occurrence or development of cardiometabolic outcomes, and determining predictive values for healthcare utilization. 

In conclusion, since no dietary assessment tool or method has been validated specifically in people with SMI to date, researchers believe that developing a targeted nutrition-risk screening tool can increase adherence for nutrition-risk screening and trigger a referral to specialist clinicians for further comprehensive nutritional assessment and appropriate plans.

 

References 

Gill, R., Tyndall, S. F., Vora, D., Hasan, R., Megna, J. L., & Leontieva, L. (2021). Diet Quality and Mental Health Amongst Acute Inpatient Psychiatric Patients. Cureus, 13(1), e12434. https://doi.org/10.7759/cureus.12434

Teasdale, S. B., Moerkl, S., Moetteli, S., & Mueller-Stierlin, A. (2021). The Development of a Nutrition Screening Tool for Mental Health Settings Prone to Obesity and Cardiometabolic Complications: Study Protocol for the NutriMental Screener. International Journal of Environmental Research and Public Health, 18, 11269. https://doi.org/10.3390/ijerph182111269

Teasdale, S.B., Ward, P. B., Samaras, K., Firth, J., Stubbs, B., Tripodi, E., & Burrows, T. L. (2019). Dietary intake of people with severe mental illness: Systematic review and meta-analysis. The British Journal of Psychiatry: The Journal of Mental Science, 214(5), 251–259. https://doi.org/10.1192/bjp.2019.20