Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review

Abstract

People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.

Barriers to Self-management of Serious Mental Illness and Diabetes

“…9 However, there are few practical and effective treatment models for people with SMI that target self-management of mental and medical disorders concurrently. 10,11 A recent literature review of studies that specifically focused on medical conditions and risk behaviors among persons with SMI found that the strength of evidence was low for most interventions. 10 While multiple studies have described self-management programs for DM and SMI individually, 12–19 few have addressed self-management of DM and SMI concurrently.…”

Developing a peer-based healthy lifestyle program for people with serious mental illness in supportive housing

“…Individualized support has been shown to be beneficial for people with SMI as it increases the frequency and duration of interventions [30] and helps address motivational and cognitive issues associated with the numerous challenges this population faces. Peer specialists, whose duties typically include a "linkage to services" function [9], are especially well-positioned to offer increased individualized support to intervention participants, as this type of support is already part of their role in managing clients' engagement with services and other service providers.…”

Lifestyle interventions to reduce premature mortality in schizophrenia

“…However, we dispute the statement that lifestyle interventions show little evidence of reducing cardiovascular risk, especially since such interventions are broadly as effective as pharmacological interventions 2 . The evidence shows that appropriately-designed behavioural interventions that provide sufficient support to patients to increase their autonomy significantly reduce cardiometabolic risk factors in the short to medium term , 3 . If maintained over the long-term, we can expect physical health outcomes and life expectancy to improve, as is well-documented in the general population 4 .…”