September 13, 2012
Improving Health and Reducing Premature Mortality in People with Severe Mental Illness
NAMHC Concept Clearance
Susan T. Azrin, Ph.D.
Chief, Primary Care Research Program
Division of Services and Intervention Research (DSIR)
The goal of this initiative is to support research on service interventions that demonstrably reduce the prevalence and magnitude of modifiable health risk factors related to shortened lifespan in people with severe mental illness (SMI).
People with severe mental illness (SMI) die prematurely from the same causes of death that affect the general population, e.g. heart disease, diabetes, cancer, stroke, and pulmonary disease, but at a more frequent rate.1,2 Specifically, adults with psychotic disorders die, on average, 11 years earlier than adults with no mental disorder, most often from these co-morbid conditions.1,3 The modifiable risk factors that contribute to early mortality—smoking, obesity, hypertension, metabolic disorder, substance abuse, low physical activity, poor fitness and diet—are also more common in people with SMI, and their onset is often earlier.3 Two-thirds or more of adults with SMI smoke;4 over 40% are obese (60% for women);5,6 and metabolic syndrome is highly prevalent, especially in women.7 Iatrogenic effects of psychiatric medications, which may include weight gain and metabolic disorder, further adversely affect the health of people with SMI, often with rapid onset.8 The 11.4 million adults with SMI in the U.S. are disproportionately affected by these conditions, and low rates of prevention, detection, and treatment result in substantial disease burden and premature mortality.1,3,9 Effective approaches to these common conditions exist. However, evidence is sparse on how to bring these effective strategies to people with SMI, who frequently experience cognitive impairment and motivational deficits.
This initiative aims to support research that builds on strategies proven effective in reducing modifiable health risk factors in the general population, and develops services interventions for large-scale delivery to people with SMI. The research generated should answer one or more of the following questions: (1) How can effective strategies to reduce health risk factors be adapted for people with SMI? (2) How can capacity to deliver needed health care be significantly improved to reach the largest number of people with SMI? (3) What strategies can best improve the implementation of effective health interventions for people with SMI? Examples of relevant research questions may include but are not limited to:
- How can multi-level medication management approaches minimize the adverse health consequences of antipsychotic medication while maintaining optimal psychiatric and functional outcomes?
- How can clinical decision support maximize screening and engagement in care for comorbid medical conditions?
- What strategies enable non-health care settings to serve as effective platforms for detection of comorbid medical conditions and linkage to treatment?
- What strategies address the unique health needs of women with SMI as well as the elevated prevalence of cardiovascular risk factors (e.g., obesity) among underserved racial and ethnic groups with SMI?
1 Druss BG, Zhao L, Von Esenwein S, et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Medical Care. 2011; 49(6):599-604.
2 Colton CW, Manderscheid, RW. Conguencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease. 2006;3(2):1-14.
3 SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008-2010.
4 Goff DC, Sullivan LM, McEvoy JP, et al. A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophrenia Research. 2005;80(1):45-53.
5 Allison DB, Fontaine KR, Heo M, et al. The distribution of body mass index among individuals with and without schizophrenia. Journal of Clinical Psychiatry. 1999;60(4):215-220.
6 McElroy SL. Correlates of overweight and obesity in 644 patients with bipolar disorder. Journal of Clinical Psychiatry. 2002;63:207-213.
7 McEvoy JP, Meyer JM, Goff DC, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: Baseline results from the (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research. 2005;80(1):19-32.
8 Allison DB, Mentore JL, Heo M, et al. Antipsychotic-induced weight gain: A comprehensive research synthesis. American Journal of Psychiatry. 1999;156(11):1686-1696.
9 Nasrallah HA, Meyer JM, Goff DC, et al. Low reates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: Data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Research. 2006;86(1-3):15-22.