Background Persons with serious mental illnesses (SMI) are more likely to die earlier than the general population, primarily due to increased medical burden, particularly from cardiovascular disease (CVD). Life Goals Collaborative Care (LG-CC) is designed to improve health outcomes in SMI through self-management, care management, and provider support. This single-blind randomized controlled effectiveness study will determine whether patients with SMI receiving LG-CC compared to usual care (UC) experience improved physical health in 12 months. Methods Patients diagnosed with SMI and at least one CVD risk factor receiving care at a VA mental health clinic were randomized to LG-CC or UC. LG-CC included five self-management sessions covering mental health symptom management reinforced through healthy behavior change; care coordination and health monitoring via a registry, and provider feedback. The primary outcome is change in physical health-related quality of life score (VR-12) from baseline to 12 months. Secondary outcomes include changes in mental health-related quality of life, CVD risk factors (blood pressure, BMI), and physical activity from baseline to 12 months later. Results Out of 304 enrolled, 139 were randomized to LG-CC and 145 to UC. Among patients completing baseline assessments (N=284); the mean age was 55.2 (SD=10.9; range 28-75 years), 15.6% were women, the majority (62%) were diagnosed with depression, and the majority (63%) were diagnosed with hypertension or were overweight (BMI mean±SD=33.3±6.3). Baseline VR-12 physical health component score was below population norms (50.0±SD=10) at 33.4±11.0. Conclusions Findings from this trial may inform initiatives to improve physical health for SMI patient populations.

Objective Persons with chronic mental disorders are disproportionately burdened with physical health conditions. We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months. Method This single-blind randomized controlled effectiveness study of a collaborative care model was conducted at a mid-western Veterans Affairs urban outpatient mental health clinic. Patients (N=293 out of 474 eligible approached) with an ICD-9-CM diagnosis of schizophrenia, bipolar disorder, or major depressive disorder and at least one cardiovascular disease risk factor were consented and randomized (02/24/10 to 04/29/15) to Life Goals (N=146) or usual care (N=147). A total of 287 completed baseline assessments and 245 completed 12-month follow-up assessments. Life Goals included five weekly sessions that provided semi-structured guidance on managing physical and mental health symptoms through healthy behavior changes, augmented by ongoing care coordination. The primary outcome was change in physical health-related quality of life score (VR-12 physical health component score). Secondary outcomes included control of cardiovascular risk factors from baseline to 12 months (blood pressure, lipids, weight), mental health-related quality of life, and mental health symptoms. Results Among patients completing baseline and 12-month outcomes assessments (N=245), the mean age was 55.3 (SD=10.8; range 28-75 years) and 15.4% were female. Intent-to-treat analysis revealed that compared to those in usual care, patients randomized to Life Goals had slightly increased VR-12 physical health scores (coefficient=3.21;p=0.01). Conclusion Patients with chronic mental disorders and cardiovascular disease risk who received Life Goals had improved physical health-related quality of life.

There was relatively high agreement for physical health conditions when self-report was compared with medical record review. As more women are increasingly represented in the military and more veterans in general seek care outside the Veterans Health Administration, accurate measurement of physical health conditions among population-based samples is crucial.