Abstract
PurposePeople with severe mental illnesses (SMI) have an increased risk of cardiovascular disease (CVD). Research in the general population suggests that social support may protect against increased CVD morbidity and mortality; however, this may not apply to those with SMI. We aimed to explore the association between perceived social support and attendance at primary care nurse CVD risk reduction clinic appointments and CVD risk-reducing behaviours in an SMI population with elevated CVD risk factors.MethodsWe used longitudinal and cross-sectional data from a randomised controlled trial on 326 adults with SMI recruited via 76 general practices in England. Multilevel regression analysis estimated the effect of perceived social support on attendance at CVD risk reduction clinic appointments over 6 months, and adherence to CVD medication, physical activity, diet, smoking and alcohol use at baseline, adjusted by age, sex, ethnicity, deprivation, psychiatric diagnosis and employment.ResultsPerceived social support predicted greater appointment attendance in unadjusted (IRR = 1.005; 1.000–1.010; p = 0.05) but not adjusted analysis (IRR = 1.003; 0.998–1.009; p = 0.25). Perceived social support was associated with greater adherence to medication; for each 1% increase in social support, there was a 4.2% increase in medication adherence (OR = 1.042; 1.015–1.070; p = 0.002). No association was found between greater perceived social support and greater physical activity, lower sedentary behaviour, healthier diet, lower alcohol use or being a non-smoker.ConclusionsSocial support may be an important facilitator for CVD medication adherence and is potentially important for primary care appointment attendance; however, alternative strategies might be needed to help people with SMI engage in physical activity, healthier diets and to reduce their smoking and alcohol use.
Highlights
People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder are at an increased risk of cardiovascular disease (CVD) and die up to 20 years earlier than the general population [1]
327 participants were recruited to the study across 76 GP practices with a mean of 4.3 patients and a range of 1–10 patients recruited per GP practice. 155 participants were randomised to the intervention group and 172 to treatment as usual
We found an association between perceived social support and attendance at primary care intervention appointments showing that each 1% increase in perceived social support was associated with a 0.5% increase in appointment attendance (IRR = 1.005; p = 0.05, 95% CI 1.000–1.011)
Summary
People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder are at an increased risk of cardiovascular disease (CVD) and die up to 20 years earlier than the general population [1]. Factors which may be responsible for this health inequality include increased smoking rates, poor diet and sedentary lifestyles [3, 4], a high rate of diabetes [5], side effects of antipsychotic medications [6] and sub-optimal management by health professionals of CVD risk in this population [7, 8]. The importance of monitoring and improving the physical health of people with SMI is endorsed by national and international guidelines [9, 10]; a UK survey of people with schizophrenia found that only 33% of respondents had attended a full CVD screening appointment in the last year [11].
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