This study was conducted in the Canadian province of Alberta, which has a population of 4.7 million as of July 1, 2023 (40). The research occurred across the acute mental health units in three main cities: Edmonton, Calgary, and Grande Prairie. The data for this study were collected as part of an ongoing pragmatic stepped-wedge cluster-randomized, longitudinal trial (41) which aimed to assess the impact of supportive text messages (Text4Support) and peer support services (PSS) on individuals with mental illness following their discharge from acute mental health facilities in Alberta (41). Participants were recruited from the nine main sites, and this study analyzed the baseline datasets retrieved from the randomized trial.

We estimated using an online app, with a margin of error of +3%, an estimated inpatient population of 28571, and a confidence interval of 95% (42)., that the sample size needed to assess the prevalence of likely problems with mobility, self-care, usual activities, pain/discomfort and depression/anxiety would be 829.

The data for this study were collected using RedCap (43)., an online platform for data collection. Participants were eligible if they were 18 or older, diagnosed with any mental health condition, ready for discharge from an inpatient mental health unit, owned a mobile device, could read English text messages, and could provide informed written consent.

The sociodemographic data collected included age, gender, ethnicity, education level, relationship status, and employment status. Also, clinical variables such as levels of depression and anxiety were collected at discharge using the PHQ9 and GAD-7, respectively. When using the PHQ-9 screening tool, a score of ten or higher indicating moderate, moderately severe and severe is recommended as a cut-off for identifying patients with likely MDD (44, 45). With the GAD-7, the scale has a range of scores from 0 to 21, with a score of ten or higher indicating moderate, moderately severe and severe is recommended as a cut-off for identifying patients with likely GAD (46). For this paper, GAD-7 scores between 10 and 21 were classified as ‘Likely Anxiety,’ and scores less than 10 as ‘Unlikely Anxiety.’ Also, PHQ-9 scores between 10 and 27 were classified as ‘Likely Depression’ and scores less than 10 were classified as ‘Unlikely Depression’. Data for this paper includes patients recruited between March 1, 2022, and November 5, 2023. After signing a paper-based consent form, data were collected from respondents before their discharge from the acute care units. All participants completed an online baseline survey with technical assistance from the research team members if needed. Phone numbers and healthcare numbers were used as primary identifiers to track responses across follow-up time points, with phone numbers specifically linking responses at the designated follow-up time points (3).

This study’s primary outcome of interest was five components of the EQ-5D-5L scale (47, 48). The EQ-5D-5L is a widely used generic, preference-based measure of health-related quality of life (HRQL). It consists of two main components: a descriptive system and a visual analogue scale (EQ-VAS). The descriptive system evaluates five dimensions of health: mobility, self-care, usual activities, pain/discomfort, and depression/anxiety (48, 49). Each dimension in the EQ-5D-5L has 5 levels where 1 is no problem, 2 slight problems, 3 moderate problems, 4 severe problems, and 5 is extreme problems. For this paper, we compiled the responses into two main categories: “No Problems” (level 1) and “Problems” (levels 2-5). The scale is considered a reliable and valid instrument that can describe health status, which in many cases can apply to a broad range of populations with between 0.65 and 0.91 test-retest reliability (47, 50).

Data analysis for this study was performed using SPSS for Mac, version 25 (IBM et al., USA) (51). Descriptive statistics focused on the respondents’ sociodemographic and clinical characteristics against ethnicity status. Univariate analysis using a chi-square test was applied to determine the association between demographic and clinical factors and the five dimensions of the EQ-5D-5L instrument. Multiple binary logistic regression models were performed to examine all the variables’ association with likely problems with mobility, self-care, usual activities, pain/discomfort, and depression/anxiety among respondents. Variables with significant (p ≤ 0.05) or near significant (0.1 > p > 0.05) association on univariate analysis were included in the binary logistic regression models. Also, a correlational analysis was used to rule out any strong intercorrelations (Spearman’s correlation coefficient of 0.7 to 1.0 or −0.7 to −1.0) between the variables. The logistic regression model was employed to identify the significant predictors of having problems in each of the five dimensions. Confidence intervals and odds ratios (OR) were reported.

The prevalence of mobility problems is 11.8%. This is lower than 60.1% reported in a study that sought to assess the health-related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh (52). The analysis of mobility problems reveals that certain demographic factors significantly increase the likelihood of experiencing these challenges. Participants aged 26 to 40 were almost twice as likely to present with mobility problems compared to younger individuals aged 25 years or less. This finding is consistent with literature suggesting that the early stages of adulthood may be associated with an increasing risk of musculoskeletal disorders or chronic conditions that affect mobility (53–55). According to reports, around 1.71 billion people globally suffer from musculoskeletal conditions. These conditions are the primary cause of disability worldwide, with low back pain being the leading cause of disability (56). Musculoskeletal disorders severely restrict mobility and dexterity, often leading to early retirement, lower well-being, and a diminished capacity to engage in social activities (56, 57).

The transition into middle age, typically involving lifestyle changes such as weight gain or decreased physical activity, could further exacerbate mobility concerns in this age group (58–60).

The finding that participants with likely depression were almost twice as likely to experience mobility problems highlights the significant interplay between mental and physical health. Depression can manifest in physical symptoms such as fatigue, pain, and reduced physical activity, all of which could contribute to mobility limitations (61, 62). Similarly, participants with likely anxiety were one and a half times more likely to report mobility problems. Anxiety can result in physical tension, muscle stiffness, and hypervigilance, leading to movement difficulties (63, 64). Thus, mental health conditions should be closely monitored and treated alongside physical health concerns to reduce mobility impairments (65).

Additionally, retired individuals were five times more likely to experience mobility problems. Retirement, while often a time for rest, can also bring about deteriorated physical health due to decreased physical activity (66). Those who are unemployed were also at an increased risk for mobility challenges, indicating that limited access to healthcare or a more sedentary lifestyle associated with unemployment may contribute to physical decline (67, 68). These findings suggest that retirement and unemployment should be critical for targeted health interventions to maintain mobility.

The prevalence of self-care problems is 8.3%. Self-care challenges are another significant health problem, and this study identifies several factors that increase the risk of such difficulties. Female participants were more likely to experience self-care issues, which is in line with prior research suggesting that women may be more prone to conditions that require more intensive self-care due to factors like hormonal changes, caregiving roles, and higher rates of certain chronic conditions, such as arthritis and fibromyalgia (69). These finding calls attention to the need for gender-sensitive healthcare approaches that consider women’s unique self-care challenges.

Moreover, individuals in the “Other” category of educational status were four times more likely to experience self-care problems. The above result suggests a strong association between lower educational attainment and difficulties with self-care. Lower level or no forms of education may be linked to reduced health literacy, poorer access to healthcare resources, and less knowledge about maintaining health, all of which contribute to challenges with self-care. Interventions focusing on health education and empowerment could significantly benefit these groups (70, 71).

Retired participants were more than four times more likely to face self-care challenges. The result is consistent with the notion that aging and physical decline accompanying retirement can lead to difficulty maintaining personal care routines (59, 72). Retirees may face increased isolation, decreased mobility, and physical conditions like arthritis, which contribute to self-care problems. Targeted programs that promote physical activity, mental health support, and accessible healthcare services could help mitigate these challenges for retirees.

Finally, the strong relationship between likely depression and self-care problems emphasizes the need to integrate mental health care with support for physical well-being. Those experiencing depression may lack the motivation or energy to engage in proper self-care, further exacerbating their health conditions (73).

The prevalence of daily activity problems is 65.8%. The high levels of daily activity issues harm social and occupational functioning. Difficulty with self-care can worsen stress levels, leading to depression, anxiety and other mental health problems. When examining the challenges related to daily activities, several demographic and mental health factors emerged as significant contributors. Participants who identified as “Other” gender were three and a half times more likely to experience problems with daily activities. This finding suggests that individuals who do not fit into traditional gender categories may face unique social or health-related challenges, possibly stemming from societal marginalization, lack of appropriate healthcare, or difficulties in accessing support networks (74, 75). These findings emphasize the importance of inclusive healthcare systems that recognize and address the needs of non-binary individuals.

Depression was also found to be a strong predictor of difficulties with daily activities, with those who are likely to be depressed three times more likely to face these challenges. Depression can significantly impair cognitive function and energy levels, making it difficult to complete routine tasks (76). Furthermore, the presence of likely anxiety increased the likelihood of daily activity problems. Anxiety can lead to difficulties in concentration and decision-making, and physical restlessness, which all interfere with daily functioning (77).

The prevalence of pain/discomfort problems is 77.7%. This is comparable to 77.7% found in a study that sought to assess the health-related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh (52). The high levels of pain/discomfort can increase the potential for reduced mobility and self-care, reduce the quality of life, and negatively impact social and occupational functioning (78, 79). Pain and discomfort are prevalent problems that impact individuals’ quality of life, and the regression analysis reveals several critical factors influencing these symptoms. Caucasian participants were found to be twice as likely to experience pain/discomfort compared to Black participants. The results suggest that racial disparities may exist in the experience or reporting of pain (80, 81). There may be cultural, socioeconomic, or healthcare access factors at play that lead to differential reporting or treatment of pain across racial groups (82). It is essential to explore these factors further to address healthcare disparities effectively.

Retirement also emerged as a significant factor, with retired individuals being three times more likely to experience pain/discomfort. The combination of aging and the reduced physical activity associated with retirement can contribute to chronic pain conditions such as arthritis or muscle stiffness (83, 84). The results underscore the importance of creating programs promoting physical activity and pain management for older adults, particularly those who are retired.

Finally, depression was strongly associated with pain/discomfort. The relationship between mental health and physical pain is well-established, as depression can exacerbate the perception of pain and contribute to chronic pain conditions (85–87). This finding reinforces the need for integrated care that addresses mental and physical health to improve the overall well-being of individuals experiencing pain/discomfort (88, 89).

The prevalence of depression/anxiety is 89.2%. This is higher than the 81.1% reported and in a study explored the ability of the EQ-5D Health Related Quality of Life measure to differentiate among those with a clinical diagnosis of major depressive episodes and/or anxiety disorders among respondents (90). These high levels of depression/anxiety increase the risks of mental and physical health conditions, employment and academic challenges, and substance misuse (91–93). It can reduce the quality of life and increase health service utilization (24, 45). Depression and anxiety are both highly influential factors in the overall health outcomes observed in this study. Depression having a profound effect on quality of life (Qol), disrupting multiple areas of daily functioning, such as physical health, social relationships, and general well-being. There is a relationship between lower Qol and both psychological and somatic symptoms of depression, with somatic symptoms often serving as stronger predictors of reduced quality of life (16, 94). Participants over 40 years old were nearly twice as likely to report depression and anxiety problems compared to younger individuals. This finding may reflect the cumulative effect of aging on both physical and mental health. As individuals age, they may experience more significant physical health challenges, loss of loved ones, or increased caregiving responsibilities, all of which could heighten the risk of depression and anxiety (95–97).

Female participants were more likely to present with depression/anxiety, further highlighting the gendered nature of mental health concerns. The greater emotional and social pressures on women, as well as potential gender disparities in healthcare access or treatment, could contribute to higher rates of depression and anxiety in this group (98, 99).

Caucasian participants were found to be nearly three times more likely to experience depression/anxiety compared to Black participants. The outcome above could point to disparities in how depression and anxiety are experienced or managed across racial groups. Cultural factors, healthcare access, and social determinants of health may all play a role in these differences (100–102).

Finally, the presence of likely depression and likely anxiety dramatically increased the likelihood of presenting with both depression/anxiety problems (103, 104). The finding emphasizes the interconnectedness of mental health conditions and the need for comprehensive mental health interventions that address both conditions simultaneously (105).

The findings of this study offer critical insights into the multifaceted determinants of poor quality of life (Qol) outcomes among individuals recently discharged from acute psychiatric care in Alberta. These insights have profound implications for policy development and clinical practice. The predictors identified across the EQ-5D-5L dimensions—mobility, self-care, usual activities, pain/discomfort, and anxiety/depression—underscore the necessity of adopting an integrated, person-centered approach to mental and physical health interventions.

From a policy perspective, the strong association between mental health conditions, particularly depression and anxiety, and physical impairments such as mobility and self-care difficulties highlight the urgent need for integrated care models. These models should prioritize collaborative care frameworks that bring together mental health professionals, primary care providers, and rehabilitation services to address both psychological and somatic symptoms in tandem. Government funding and health authority support should be directed toward multidisciplinary outpatient programs explicitly designed for psychiatric discharge populations, emphasizing early intervention and continuity of care.

The data also emphasize the importance of addressing social determinants of health, including employment status, education, and retirement. The elevated risk of mobility and self-care challenges among retired and unemployed individuals calls for targeted policy measures that promote physical activity, social engagement, and accessible community support for these groups. Health promotion programs tailored to older adults and those not in the labor force, especially those living alone or with limited mobility, should be scaled and adapted to reduce isolation and maintain functional independence.

Educational disparities also emerged as significant, particularly among individuals categorized under “Other” educational backgrounds, who were more prone to self-care and daily activity limitations. This finding advocates for policies that enhance health literacy, particularly among marginalized or undereducated populations. Health education initiatives, delivered through community health centers, adult learning programs, and culturally tailored outreach, can empower individuals with the knowledge and resources to manage their physical and mental health more effectively.

Gender and racial disparities observed in this study further indicate the need for equity-informed health policies. Women were more likely to experience self-care and mental health issues, likely due to a complex interplay of caregiving roles, hormonal factors, and societal expectations. Policy responses must support gender-sensitive healthcare services, including access to mental health support, caregiver respite programs, and routine screening for chronic conditions disproportionately affecting women.

The greater likelihood of pain/discomfort and anxiety/depression among Caucasian participants compared to Black participants suggests the presence of culturally mediated differences in healthcare access, symptom reporting, or coping strategies. These findings support the development of culturally competent healthcare services that consider how race, identity, and lived experiences shape mental and physical health outcomes. Enhanced training for healthcare providers in cultural safety and anti-racism practices is essential to reducing disparities and building trust among diverse patient populations.

Finally, for clinical practice, the consistent role of depression and anxiety across all Qol domains supports routine mental health screening post-discharge and the inclusion of psychological support in all care plans. Clinicians should receive training to recognize the physical manifestations of mental illness and vice versa, ensuring holistic assessments and interventions. Together, these measures can significantly improve post-discharge outcomes and long-term recovery for individuals transitioning from psychiatric care back into the community.