Why Do People with Severe Mental Illness Have Poor Cardiovascular Health?—The Need for Implementing a Recovery-Based Self-Management Approach

Abstract

People with severe mental illness (SMI) die significantly earlier than their well counterparts, mainly due to preventable chronic conditions such as cardiovascular disease (CVD). Based on the existing research, this perspective paper summarises the key contributors to CVD in people with SMI to better target the areas that require more attention to reduce, and ultimately resolve this health inequity. We discuss five broad factors that, according to current international evidence, are believed to be implicated in the development and maintenance of CVD in people with SMI: (1) bio-psychological and lifestyle-related factors; (2) socio-environmental factors; (3) health system-related factors; (4) service culture and practice-related factors; and (5) research-related gaps on how to improve the cardiovascular health of those with SMI. This perspective paper identifies that CVD in people with SMI is a multi-faceted problem involving a range of risk factors. Furthermore, existing chronic care or clinical recovery models alone are insufficient to address this complex problem, and none of these models have identified the significant roles that family caregivers play in improving a person’s self-management behaviours. A new framework is proposed to resolve this complex health issue that warrants a collaborative approach within and between different health and social care sectors.

Impact of the mental health reform in Israel on health care and mortality among people with severe mental illness

“…While the performance of an annual LDL test is not part of NQIP's recommendations for service users with SMI, it was done more frequently among them. As LDL test is related to risk factors for CVD, this may be explained by other risk factors, such as smoking, overweight, and a high blood pressure, which are known to be more prevalent among people with SMI, and lead GPs to enhance referral to perform the [27][28][29]. Unfortunately, in our data we had many missing values of these risk factors, thus preventing their inclusion in the analysis.…”

Severe Mental Illness and Non-specific Abdominal Pain in the Emergency Department: A Multi-institutional Database Study

“…Patients with severe mental illness (SMI) are considered vulnerable due to several factors, including higher rates of comorbidities, poorer socioeconomic support, and atypical disease presentation of their illness (5)(6)(7). A previous study found that patients with major depressive disorder had higher ED revisit rates when diagnosed with NSAP (8).…”

Editorial: Mortality of people with severe mental illness: Causes and ways of its reduction

“…Editorial on the Research Topic Mortality of people with severe mental illness: Causes and ways of its reduction Severe mental disorders (SMD) are associated with a variety of other illnesses and have poorer health outcomes and higher mortality than other non-communicable disease (1)(2)(3). People with severe mental disorders die on average 10-20 years earlier than the general population (4); this gap is increasing over time and recent data suggest that their standardized mortality ratios are higher than those previously reported (5). Only a minority of deaths of people with SMD are attributable to unnatural causes, such as suicide, homicide or accidents (6,7): the majority of deaths are due to physical disorders, such as cardiovascular, respiratory and infectious diseases, diabetes mellitus and cancers (8,9).…”