How to improve the physical health of people with severe mental illness? A multicentric randomized controlled trial on the efficacy of a lifestyle group intervention.

Mario Luciano,Rodolfo Rossi,Giorgio Di Lorenzo,Valeria Del Vecchio,Vincenzo Giallonardo,Gaia Sampogna,Pietro Calcagno,Andrea Fiorillo,Claudia Carmassi,Ileana Andriola,Alberto Siracusano,Liliana Dell’Osso,Barbara Gelao,Mario Amore,Alessandro Rossi

doi:10.1192/j.eurpsy.2021.2253

Abstract

People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients' body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes. This is a multicentric RCT with blinded outcome assessments carried out in six Italian university centers. After recruitment patients were randomized to receive a 6-month psychosocial intervention to improve patients' physical health or a brief psychoeducational intervention. All recruited patients were assessed with standardized assessment instruments at baseline and after 6months. Anthropometric parameters and blood samples have also been collected. Four-hundred and two patients with a diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were randomly allocated to the experimental (N=206) or the control group (N=195). After 6months, patients from the experimental group reported a significant reduction in BMI (odds ratio [OR]: 1.93, 95% confidence intervals [CI]: 1.31-2.84; p<0.001), body weight (OR=4.78, 95% CI: 0.80-28.27, p<0.05), and waist circumference (OR=5.43, 95% CI: 1.45-20.30, p<0.05). Participants with impaired cognitive and psychosocial functioning had a worse response to the intervention. The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings.

Highlights

People with severe mental illnesses (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to suffer from obesity, diabetes, dyslipidemias, and metabolic syndrome with an increase of cardiovascular risk [1,2,3,4,5,6,7] and a reduced life expectancy of up to 25 years compared with the general population, representing a major public health concern [8,9,10,11,12,13] and a priority for health agencies and national governments [14]
The LIFESTYLE trial represents the first multicenter study carried out in Italy aiming to assess the impact of a psychosocial intervention targeting lifestyle behaviors in people with SMI in real-world settings
Effective interventions for improving physical health in people with severe mental disorders are highly needed in order to reduce the premature mortality in this vulnerable group of people [11]

Summary

Introduction

People with severe mental illnesses (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to suffer from obesity, diabetes, dyslipidemias, and metabolic syndrome with an increase of cardiovascular risk [1,2,3,4,5,6,7] and a reduced life expectancy of up to 25 years compared with the general population, representing a major public health concern [8,9,10,11,12,13] and a priority for health agencies and national governments [14].Several factors can contribute to the poor physical health in this patient population. People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients’ body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes. The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings

Objectives

Methods

Results

Conclusion